Left Ventricular Aneurysm Formation Research Articles

Association of monocyte to HDL cholesterol ratio and a composite risk score with left ventricular aneurysm formation in patients with acute ST-segment elevation myocardial infarction.

Left ventricular aneurysm (LVA) is an important complication of acute myocardial infarction. This study aimed to investigate the potential predictive value of the monocyte count to high-density lipoprotein cholesterol ratio (MHR) and a composite risk score in determining the formation of LVA in patients with acute ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention. We recruited 1005 consecutive patients with STEMI. Multivariable logistic regression analysis was conducted identify the independent risk factors for LVA formation. Predictive power of MHR and composite risk score for LVA formation were assessed using receiver operating characteristic curve analysis. The MHR was significantly higher among patients with LVA compared to those without LVA [6.6 (3.8-10.8) vs. 4.6 (3.3-6.3), P < 0.001]. Univariable logistic regression analysis revealed that MHR (OR = 3.866, 95% CI = 2.677-5.582, P < 0.001) was associated with the risk of LVA formation. The predictive value of MHR remained significant even after multivariate logistic regression analysis [odds ratio (OR) = 4.801, 95% confidence interval (CI) = 2.672-8.629, P < 0.001]. The discriminant power of MHR for LVA is 0.712, which is superior to both monocyte (C statistic = 0.553) and high-density lipoprotein cholesterol (C statistic = 0.654). The composite risk score including MHR, gender, LVEF, hemoglobin, lymphocyte and left anterior descending artery as the culprit vessel could significantly increase the predictive ability (C statistic = 0.920). A higher MHR could effectively identify individuals at high risk of LVA formation, especially when combined with gender, LVEF, hemoglobin, lymphocyte and left anterior descending artery as the culprit vessel.

Urea nitrogen-to-albumin ratio predicts ventricular aneurysm formation in ST-segment elevation myocardial infarction.

Left ventricular aneurysm (LVA) is an important complication of acute myocardial infarction. The aim of this study was to investigate the possible predictive value of blood urea nitrogen-to-albumin ratio (BAR) for the LVA formation in acute ST-segment elevation myocardial infarction (STEMI) patients who underwent primary percutaneous coronary intervention (PCI). A total of 1123 consecutive patients with STEMI were prospectively enrolled. The clinical and laboratory data were compared between LVA group and non-LVA group. Multivariable logistic regression analysis was performed to assess the independent risk factors of LVA formation. Predictive power of BAR and composite variable for LVA formation were assessed using receiver operating characteristic curve. LVA was detected in 162 patients (14.4%). The BAR was significantly higher in patients with LVA [0.16 (0.13-0.19) vs. 0.13 (0.10-0.17), P<0.001]. Multivariable logistic regression analysis revealed that left ventricular ejection fraction (LVEF) [odds ratio (OR)=0.865, P<0.001], culprit vessel-left anterior descending artery (LAD) (OR=4.705, P<0.001), and BAR (OR=2.208, P=0.018) were all independent predictors for LVA formation. The predictive value of BAR remained significant even after cross-validation by splitting population into training set (OR=1.957, P=0.034) and validation set (OR=1.982, P=0.039). The maximal length and width of LVA were significantly increased in patients with BAR≥0.15 when compared with BAR<0.15 (3.37±1.09 vs. 2.92±0.93, P=0.01, for maximal length, and 2.20±0.55 vs. 1.85±0.63, P=0.001, for maximal width). The discriminant power of BAR for LVA is 0.723, which is superior to both blood urea nitrogen (C statistic=0.586, P<0.001) and albumin (C statistic=0.64, P<0.001). The combination of BAR, LVEF, and culprit vessel-LAD could significantly increase the predictive ability (C statistic=0.874, P<0.001, for vs. BAR). Subgroup analysis of age, sex, hypertension, diabetes, smoking, LVEF, serum albumin, multiple-vessel disease, and Gensini score had no effect on the association between BAR and risk of LVA formation (P<0.05 for all subgroups). A higher BAR was an independent predictor for LVA formation in STEMI patients with primary PCI.

Left ventricular aneurysm formation in patients with takotsubo syndrome: A peculiar phenomenon with subtle implications.

Left ventricular aneurysm formation in patients with takotsubo syndrome: A peculiar phenomenon with subtle implications.

Left ventricular aneurysm formation in patients with Takotsubo syndrome: A peculiar phenomenon with subtle implications. Author's reply.

Left ventricular aneurysm formation in patients with Takotsubo syndrome: A peculiar phenomenon with subtle implications. Author's reply.

The proGnostic role of caRdiac rehAbilitation in patients with left ventriCular anEurysm formation after anterior myocardial infarction (the GRACE study): Study rationale and design of a prospective randomized controlled trial.

Cardiac rehabilitation (CR) is an essential intervention after acute myocardial infarction (MI). However, it is still unclear whether patients with left ventricular aneurysm (LVA) formation after anterior MI would benefit from CR programs. This clinical trial is designed to assess the role of CR in patients with LVA formation after anterior MI. The GRACE study is a single-center, single-blind, prospective, randomized controlled clinical trial in China. 100 subjects aged 18-75 years with LVA formation after anterior MI will be recruited and randomized 1:1 to the CR or control group. Both groups will receive standard drug treatment and routine health education according to the guidelines. Participants in the CR group will additionally receive tailored CR programs delivered over a period of 36 sessions. These participants will then be followed up for 1-year. The primary outcome is peak oxygen uptake measured by cardiopulmonary exercise testing after CR programs. The secondary outcomes are cardiac function and EuroQol 5-Dimension-3 Level index scores after CR program and 1-year and major adverse cardiac cerebrovascular events, a composite of cardiovascular mortality, non-fatal MI, non-fatal stroke, malignant arrhythmia or hospitalization for heart failure during the follow-up period. This single-center, single-blind, prospective, randomized controlled clinical trial will determine whether CR improves physical capacity and clinical outcomes in patients with LVA formation after anterior MI. Chinese Clinical Trial Registry ChiCTR2200058852. Registered on 18 April 2022.

Utilidade do Nível de NT-Pro-BNP no Plasma à Internação em Predizer a Formação de Aneurisma do Ventrículo Esquerdo após Infarto Agudo do Miocárdio com Elevação do Segmento ST

BackgroundLeft ventricular aneurysm (LVA) is an important complication of acute myocardial infarction. In this study, we investigated the role of N- Terminal pro B type natriuretic peptide level to predict the LVA development after acute ST-segment elevation myocardial infarction (STEMI).MethodsWe prospectively enrolled 1519 consecutive patients with STEMI. Patients were divided into two groups according to LVA development within the six months after index myocardial infarction. Patients with or without LVAs were examined to determine if a significant relationship existed between the baseline N- Terminal pro B type natriuretic peptide values and clinical characteristics. A p-value < 0.05 was considered statistically significant.ResultsLVA was detected in 157 patients (10.3%). The baseline N- Terminal pro- B type natriuretic peptide level was significantly higher in patients who developed LVA after acute MI (523.5 ± 231.1 pg/mL vs. 192.3 ± 176.6 pg/mL, respectively, p < 0.001). Independent predictors of LVA formation after acute myocardial infarction was age > 65 y, smoking, Killip class > 2, previous coronary artery bypass graft, post-myocardial infarction heart failure, left ventricular ejection fraction < 50%, failure of reperfusion, no-reflow phenomenon, peak troponin I and CK-MB and NT-pro BNP > 400 pg/mL at admission.ConclusionsOur findings indicate that plasma N- Terminal pro B type natriuretic peptide level at admission among other variables provides valuable predictive information regarding the development of LVA after acute STEMI.

True left ventricular aneurysm in acute myocardial infarction: immediate and long-term outcomes, prognostic factors, and treatment

An important place in the structure of cardiovascular morbidity is occupied by myocardial infarction (MI), especially complicated MI, including complicated by the formation of left ventricular (LV) aneurysm. The latter is a very formidable complication and leads to such life-threatening conditions as ventricular arrhythmias, heart failure, thromboembolism. The purpose of the review is to analyze the publications of foreign and Russian authors on risk factors, outcomes and treatment of patients with postinfarction LV aneurysm. Attention is paid to the role of registers in the study of this problem, as well as the analysis of literature data on the prevalence of such a complication as MI during the COVID-19 pandemic (COrona VIrus Disease 2019). It is shown that the registers of acute coronary syndrome, as a rule, do not contain separate data on patients with a formed LV aneurysm, risk factors for its development and outcomes in this group of patients. Postinfarction LV aneurysm can form only after transmural MI; therefore, it is important to keep records of patients diagnosed with transmural MI, primarily in the form of a register.

Surgical Ventricular Reconstruction Eligible for Late Assist Device Implantation

In patients with ischemic cardiomyopathy and left ventricular aneurysm formation who are symptomatic despite optimal medical therapy, it is challenging to determine whether surgical ventricular reconstruction, heart transplantation, or left ventricular assist device (LVAD) implantation is the treatment of choice. This report describes the concept of surgical ventricular reconstruction with a specially prepared LVAD fixation ring to facilitate subsequent LVAD implantation if required. In the patient reported in this case, endoventricular circular LVAD ring plasty sufficiently reduced the ventricular volume, normalized the left ventricular geometry, and subsequently led to an improvement of left ventricular ejection fraction.

Optimizing the treatment approach for ST-segment elevation myocardial infarction in the chest leads

BACKGROUND: The treatment of ST-segment elevation myocardial infarction (STEMI) in both chest and other leads chose a single course of mandatory use of percutaneous coronary interventions (PCI) in the first 12 h from the onset of pain. However, a significant proportion of patients, often older age groups, are hospitalized at later terms. Thus, studying the efficiency of primary PCIs in different age groups is of interest, considering the terms of hospitalization and characteristics of thanatogenesis in the absence of reperfusion therapy and with its use.&#x0D; AIM: This study aimed to optimize the treatment approach of patients with STEMI in the chest leads using the primary percutaneous coronary interventions (PCI) during hospitalization in the first 12 h and subsequent 1272 h, taking into account the initial risk of death at different ages groups.&#x0D; MATERIALS AND METHODS: The study included 804 patients with anterior STEMI, who were admitted to the institute from 2008 to 2017. Early PCI was performed in the first 12 h in 311 patients, whereas 272 patients underwent delayed interventions at hospitalization after 1272 h; additionally, 221 patients, including 124 cases with coronary angiography with late hospitalization, received drug therapy. In early PCI, the ratio of individuals under 65 years, 6575 years, and over 75 years were 176, 73, and 62, whereas 164, 66, and 42 in delayed PCI, and 126, 47, and 48 without intervention, respectively. In 26 deceased patients after PCI and 39 patients without interventions, the state of the coronary arteries (CA), the area of left ventricular (LV) lesion, and the cause of death were determined.&#x0D; RESULTS: The absence of reperfusion therapy in the form of PCI in anterior STEMI was established to lead to a progressive decreased myocardial contractile function and formation of an extensive LV aneurysm and high mortality rate, especially in older age groups. Early PCI preserves the contractile function, prevents the LV aneurysm, and significantly reduces mortality. The use of delayed PCI prevents LV dysfunction progression, limits the formation of LV aneurysm, and reduces mortality, which remains high in the absence of PCI. However, delayed PCI, contrary to early used interventions without age restrictions, is mainly performed for isolated lesions, much less often for multiple lesions that are more often present in elderly and senile people. Severe CA disease in these categories of patients increases the risk of intraprocedural complications. Nevertheless, without PCI, a lethal outcome is inevitable in many of them. Thanatogenesis in anterior STEMI is based on the proximal lesion of the anterior interventricular branch in combination with three-vessel CA disease, which causes an extensive infarction area with fatal complications.&#x0D; CONCLUSIONS: The delayed PCI, by analogy with early used procedures without limitations, optimizes the treatment approach of MI with ST-segment elevation in the chest leads and minimizes mortality in all age groups.

Treatment of Complicated Coronary Heart Disease after Successful Prehospital Resuscitation in a Public Place

The current problem of modern medicine is the lack of public awareness about personal health, late diagnosis of diseases, untimely prehospital care and treatment of existing complications. This applies to all branches of medicine, especially cardiology and cardiac surgery. Coronary heart disease occupies one of the leading places in the structure of mortality due to cardiovascular diseases. This is mainly due to the fact that patients seek medical care with complicated forms of coronary heart disease like sudden cardiac death, cardiac arrhythmia (ventricular fibrillation, AV blockade, sinus bradycardia and tachycardia), formation of left ventricular (LV) aneurysm, LV free wall rupture and LV false aneurysm, mitral regurgitation. In such cases, all actions must be early, staged, well established, and concordant with clear algorithm.&#x0D; The aim. To demonstrate our clinical case as an example of proper logistics, rapid response and timely surgical treatment of complicated forms of coronary heart disease.&#x0D; Clinical case. Patient F., born in 1964, was admitted to the clinic on March 24, 2021 with a diagnosis of coronary heart disease: acute non-Q-wave myocardial infarction of the posterolateral LV since March 22, 2021. Clinical death with successful resuscitation at the prehospital stage (03/22/2021). Ventricular fibrillation (03/22/2021). Multivessel coronary artery disease. Mitral valve regurgitation grade II-III. Tricuspid valve regurgitation grade I-II. Pulmonary hypertension grade I. Hypertensive disease grade III, degree 3, risk 4 (very high). Heart failure II A with a moderately reduced LV ejection fraction (47%). NYHA3. Closed chest injury (03/22/2021): fracture of the ribs without displacement: ribs 4-8 on the left, ribs 4-8 on the right. He considers himself ill since March 22, 2021, when he suddenly felt severe pain in his chest and fell unconscious. According to witnesses, the man got out of the subway and fell unconscious, without breathing and pulse. Due to the presence of defibrillators at the subway station, successful resuscitation was conducted by police officers before the ambulance crew arrival. Clinical and instrumental studies were performed after hospitalization. The patient was taken to the operating room on 03/24/2021 at 5:30 PM, 50 minutes after admission to the National Amosov Institute, Kyiv. Urgent off-pump coronary artery bypass grafting of 3 coronary arteries was performed. A cardioverter-defibrillator was implanted due to the history of clinical death and the conclusion of daily ECG monitoring. The intra- and postoperative period was uneventful, the patient was discharged in satisfactory condition for rehabilitation.&#x0D; Conclusions. Our clinical experience shows that timely prehospital care, proper logistics and surgical correction of coronary heart disease not only saves but also significantly improves the quality of life of the patient in the future.

Predictors and long-term prognosis of left ventricular aneurysm in patients with acute anterior myocardial infarction treated with primary percutaneous coronary intervention in the contemporary era.

BackgroundPrimary percutaneous coronary intervention (PCI) has been the standard reperfusion strategy for patients with acute myocardial infarction (AMI) in the contemporary era. Meanwhile, the incidence and prognosis of left ventricular aneurysm (LVA) in AMI patients remain ambiguous. The aim of the current study is to identify the predictor and long-term prognosis of LVA in patients with acute anterior myocardial infarction.MethodsWe prospectively enrolled 942 consecutive patients with acute anterior myocardial infarction who were treated by primary PCI. The baseline characteristics, procedural features, and one-year clinical outcomes were compared between the patients with and without LVA. The primary endpoint of major adverse cardiovascular and cerebrovascular events (MACCEs) was defined as a composite of cardiac death, target vessel revascularization, and ischemic stroke. Multiple logistic regression was applied to predict LVA formation and the receiver operating characteristic (ROC) curves were plotted to evaluate the accuracy of the multivariate analysis model.ResultsThe general incidence of LVA was 15.92%. At one-year clinical follow-up, patients in the LVA group had significantly higher incidence of MACCEs (15.33% vs. 6.44%, P<0.01), mainly driven by an increased incidence of cardiac death (8.00% vs. 2.78%, P<0.01), target vessel revascularization (5.33% vs. 2.27%, P=0.03), and ischemic stroke (4.00% vs. 1.39%, P=0.03). Multivariate analysis found that longer symptom-to-balloon time (S2B) [odds ratio (OR): 1.16, 95% confidence interval (CI): 1.11–1.21, P<0.01], higher initial and residual SYNTAX score (iSS, OR: 1.19, 95% CI: 1.14–1.24, P<0.01; rSS, OR: 1.33, 95% CI: 1.22–1.45, P<0.01), lower left ventricular ejection fraction (LVEF) (OR: 1.15, 95% CI: 1.11–1.18, P<0.01), and persistent ST segment elevation (OR: 1.89, 95% CI: 1.06–3.38, P=0.03) were independent predictors of LVA formation.ConclusionsLVA is still common in patients with acute anterior myocardial infarction in the contemporary PCI era, and the prognosis of these patients was significantly worse during the one-year clinical follow-up. Strategies of prompt reperfusion and complete revascularization may be helpful in preventing LVA formation and improving clinical outcomes.

Epicardial adipose tissue is associated with the formation of left ventricular aneurysm after myocardial infarction

Abstract Background Left ventricular aneurysm (LVA), a serious complication of transmural myocardial infarction, is generally related to poor cardiovascular outcomes. The formation of LVA is essentially an inflammatory remodeling process regulated by multiple systemic and local factors. Epicardial adipose tissue (EAT), a depot of visceral adipose tissue directly overlying the myocardium, is increasingly recognized as an important immune organ by secreting a variety of bioactive adipocytokines. However, the relation of EAT to the development of LVA is still unclear. Purpose In this study, we sought to investigate the association between EAT volume and the formation of LVA in subjects with previous myocardial infarction (MI). Methods A total of 55 subjects with previous MI and the presence of LVA, and age- and sex-matched 50 subjects with previous MI but without LVA were enrolled between October 2011 and June 2019. EAT was quantified and the presence of LVA was ascertained by cardiac magnetic resonance (CMR). EAT volume was indexed to body surface area. Results In the overall population, EAT volume index was correlated positively to log-transformed N-terminal pro-brain natriuretic peptide (NT-proBNP) levels (Pearson's r=0.332, P=0.002), and inversely to left ventricular ejection fraction (LVEF; Pearson's r=−0.240, P=0.031). The indexed EAT volume was significantly higher in subjects with than without LVA (41.10±11.73 vs. 33.25/11.70 mL/m2, P=0.003). In subjects with LVA, EAT volume index was further increased in those at older age (43.59±13.09 mL/m2 vs. 37.29±8.26 mL/m2, P=0.029) or with type 2 diabetes (43.38±12.32 mL/m2 vs. 35.20±7.67 mL/m2, P=0.013). After adjusting for sex, age and the presence of diabetes in the multivariate analysis, tertiles of EAT volume index remained significantly associated with the presence of LVA (P for trend=0. 003). Strikingly, compared to the lowest tertile (≤30.80 mL/m2), the intermediate (30.80–44.13 mL/m2) and highest (&amp;gt;44.13 mL/m2) tertiles of EAT volume index corresponded to 4.869– (95% CI 1.792–14.155, P=0.003) and 4.876– (95% CI, 1.787–14.206, P=0.003) increased risk for LVA. Conclusion Our study suggests that EAT volume is independently associated with the formation of LVA and reduced cardiac function after myocardial infarction. EAT in patients with or without LVA Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Natural Science Foundation of China

Correlations between morphological features of intracoronary thrombi and left ventricular structure and function in patients with ST-segment elevation myocardial infarction

The majority of cases of acute ST-elevation myocardial infarction (STEMI) are caused by the rupture of an atherosclerotic plaque and subsequent thrombus formation. The study of clot structure may be important for the prediction of further course of the disease. The study included 100 patients with STEMI who underwent primary percutaneous coronary intervention (PCI) with manual thromboaspiration within the first 12 hours after the onset of symptoms. Sufficient aspiration material for histological examination was obtained in 97 patients. These intracoronary thrombi were investigated macroscopically and microscopically. Subsequently, correlations between morphological structure of thrombi and structural and functional features of the myocardium after revascularization were analyzed. Pathological QS pattern was detected in 45 (46.39±5.06%) patients. Peripheral infiltration of intracoronary thrombus with neutrophils was the only morphological feature associated with the presence of QS (r= -0.36; p&lt;0.001). The mean left ventricular ejection fraction (LVEF) measured during echocardiography was 48.34±9.39%. Positive and significant correlation was found between LVEF and peripheral infiltration of intracoronary thrombus with neutrophils (r=0.37; p&lt;0.001), while negative correlation was found between LVEF and presence of microchannels within the clot (r= -0.27; p&lt;0.01). The mean total segmental left ventricular contractility index at the time of hospital discharge was 1.38 [1.25; 1.63]. This index negatively correlated with neutrophil infiltration (r= -0.37; p&lt;0.001), and positively – with the presence of microchannels in the obtained clot samples (r=0.26; p=0.01). Signs of left ventricular aneurysm formation before discharge from the hospital were found in 15 (15.46±3.67%) patients. A significant negative correlation was found between this parameter and the presence of peripheral neutrophil infiltration of intracoronary thrombi (r= -0.32; p&lt;0.01). The presence of peripheral infiltration of intracoronary thrombi with neutrophil leukocytes was associated with better left ventricular systolic function and less likely hood of development of left ventricular aneurysm or electrocardiographic QS pattern. The formation of microchannels within the clot was associated with poorer recovery of systolic cardiac function.

EVALUATION OF THE RELATION BETWEEN PLATELET COUNT AFTER PRIMARY PCI AND LEFT VENTRICULAR ANEURYSM IN PATIENTS WITH ACUTE ANTERIOR ST ELEVATION MYOCARDIAL INFARCTION

Objective: To evaluate the relationship between platelet count after primary percutaneous coronary intervention (p-PCI) and left ventricular aneurysm (LVA) in patients with acute anterior ST-elevation myocardial infarction(STEMI). Methodology: This descriptive study was performed on a population of patients with acute anterior STEMI, who had undergone p-PCI. Sampling was carried out by a consecutive survey of patients, who were admitted to the Medical Center in summer and fall of 2018. Blood samples were collected intravenously from all the patients at admission to the emergency department before and after p-PCI. Echocardiographic examinations were routinely performed by a specialist assistant as the co-author 8 to 12 hours after p-PCI and at follow-up (10 to 14 months after acute MI). The TIMI flow was observed immediately after p-PCI. In all the patients undergoing p-PCI, the location of left anterior descending (LAD) artery involvement during coronary arteries angiography was divided into three sections based on LAD artery length. Results: The mean WBC and PMN before p-PCI were statistically higher in the group of patients with LVA compared to individuals without LVA (p&lt;0.001). Based on multivariate analysis platelet count (OR=0.999, age (OR=1.07), PMN before P-PCI (OR=1.001) had a significant additive effect on the probability of LVA formation. Conclusion: Platelet count can be used for prediction of the risk of future LVA formation in acute STEMI patients. Key words: ST-segment elevation myocardial infarction; platelet count; mortality; percutaneous coronary intervention; left ventricular aneurysm

Predictive risk factors of early onset left ventricular aneurysm formation in patients with acute ST-elevation myocardial infarction

BackgroundLeft ventricular aneurysm (LVA) is a severe complication of ST-elevation myocardial infarction (STEMI) and is associated with poor prognosis due to high mortality. However, predictors of LVA formation in early period are inadequately defined. ObjectivesThe purpose of this study is to determine potential predictors of LVA formation in early period (<15 days after admission) after acute STEMI. MethodsThe present study was retrospectively conducted involving 1823 STEMI patients based on the AMI database of our clinic between January 2013 and April 2019. Among STEMI patients with regional wall motion abnormality (RWMA), the baseline, angiographic, procedural characteristics of patients with early-onset LVA and controls without LVA were compared. The controls were matched 2:1 with LVA cases for the admission date. Patients with prior myocardial infarction, non-ischemic cardiomyopathy, severe heart valve disease, and patients without coronary angiography were excluded. The odds ratio (OR) and confidence interval (CI) were obtained by logistic regression analysis and all statistical analysis were performed by SPSS 25.0. ResultsAmong 1823 STEMI patients who underwent coronary angiography, 103 eligible patients (median age 67 years) had LVA and were compared to 206 patients without LVA (median age 60 years). In multivariate analysis, RWMA in the left ventricular anterior wall (OR 13.17, 95%CI 2.21–78.57, p=0.005) was found to be the most striking predictor of LVA, followed by RWMA in the apex (OR 7.93, 95%CI 2.22–28.30, p=0.001). Female sex (OR 3.91, 95%CI 1.54–9.93, p=0.004), peak N-terminal pro brain natriuretic peptide (NT-pro BNP,OR 1.08, 95%CI 1.01–1.16, p=0.031), time between onset of pain and balloon time (OR 1.01, 95%CI 1.00–1.01, P=0.016), and presence of QS-waves on initial electrocardiogram (OR 3.06, 95%CI 1.49–6.27, P=0.016) were independently associated with LVA formation. ConclusionThis study indicated that female sex, peak NT-pro BNP, the time between the onset of pain and balloon time, presence of QS-waves on initial electrocardiogram, RWMA of left ventricular anterior wall and apex were the independent predictors of early-onset LVA in patients with acute STEMI.

Left Ventricular Aneurysmectomy and Repair of Post-infarct Ventricular Septal Defect with Concomitant Aortocoronary Bypass Grafting: A Video Presentation

Mechanical complications resulting from myocardial infarction usually have profound acute or chronic hemodynamic effects. Left ventricular aneurysm formation and ventricular septal rupture occurs in 10-20% patients after acute myocardial infarction [1-6]. Surgical techniques have gradually evolved since the first successful operation for post-infarct ventricular septal defect was performed by Cooley and colleagues in 1956 [2,3,6].

Effect of Collateral Circulation on Left Ventricular Systolic Function in Patients with Totally Occluded Artery Undergoing PCI

Background: Over the past three decades, accumulating evidence has documented that pre-existing welldeveloped CCC at the onset of acute myocardial infarction plays an important role in preserving left ventricular function, reducing infarct size, preventing left ventricular aneurysm formation, and survival. Objective: The aim of this study is to evaluate the effect of collateral circulation as measured by Rentrop score on left ventricular regional and global systolic function in patients with totally occluded vessel pre and post PCI and the ensuing impact of successful PCI. Methodology: Sixty patients have single vessel coronary chronic total occlusion with viable myocardium of CTO related territories, successful revascularization at ERMED and ICS, between June 2017 and December 2018, were considered to participate in this prospective study, The study subjects were divided into three groups according to Rentrop score , each group contain 20 patients : Group (I) Rentrop score 0 , Group (II) Rentrop score 1 and Group (III) Rentrop score 2. Results: There was no statistically significant difference between the three groups regarding the incidence of diabetes, smoking and hypertension. There was high statistically significant difference in EF between each group after revascularization, EF was higher in group (III) than group (I) and group (II). There was statistically significant difference in WMSI comparison between each group after revascularization WMSI was lower in group (III) than group (I) and group (II). Conclusion: In general increase Rentrop score before revascularization lead to more improvement in WMSI and EF after successful revascularization with improvement of quality of life.

Impaired renal function and abnormal level of ferritin are independent risk factors of left ventricular aneurysm after acute myocardial infarction

This study was performed to determine the prognostic value of glomerular filtration rate (GFR) and ferritin compromised in left ventricular aneurysm (LVA) patients who suffered acute myocardial infarction (AMI) beforehand.A hospital-based case–control study was conducted in the Department of Cardiology, First Affiliated Hospital, Zhejiang University in 2013 and 2014. Patients were divided into 3 groups according to kidney function and ferritin level. Observation outcomes include age, sex, C-reaction protein (CRP), medical history including major risk factors for CAD, ferritin and GFR, previous angina, time between MI and coronary angiography or time to rescue (TTR), and prior treatment.Around 60 patients were included in the case group (AMI with LVA) and 133 matched patients (AMI without LVA) in the control group. The prevalence of single-vessel disease (odd ratio [OR] = 2.490; 95% confidential interval [95% CI] = 1.376–4.506; P = .002), total LAD occlusion (OR = 1.897; 95% CI = 1.024–3.515; P = .041), absence of previous angina (OR = 1.930; 95% CI = 1.035–3.600; P = .037), time between myocardial infraction (MI) and coronary angiography more than 12 h (OR = 1.970; 95% CI = 1.044–3.719; P = .035), GFR less than 60 mL/min (OR = 2.933; 95% CI = 1.564–5.503; P = .001), and ferritin levels (P = .0003) were all higher in the aneurysm group compared with those in the control group. After adjustments for other variables, single-vessel disease (OR = 1.211; 95% CI = 1.080–1.342; P = .02), GFR lower than 60 mL/min (OR = 1.651; 95% CI = 1.250–2.172; P = .013), and high or low levels of ferritin (OR = 1.151; 95% CI = 1.050–1.252; P = .042) remained the independent determinants of LVA formation after AMI.Decreased GFR and abnormal ferritin levels are independent risk factors of LVA formation after AMI.

The relationship between post-procedural platelet count and left ventricular aneurysm in patients with acute anterior ST-segment elevation myocardial infarction following primary percutaneous coronary intervention.

Left ventricular aneurysm (LVA) relates to worse prognosis in patients with myocardial infarction despite successful reperfusion treatment. There is no evidence that early detectable biomarkers can predict the risk for the future development of LVA. The aim of our study was to investigate the possible predictive value of periprocedural haematological parameters for LVA. A total of 281 patients with acute anterior ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (pPCI) were enrolled. Haematological parameters were measured on admission before pPCI and between 8 and 12 h after pPCI, separately. The development of LVA was evaluated at one-year follow-up. The patients were then divided into two groups: an LVA group and a non-LVA group. Univariate and multivariate logistic regression analyses were performed to find the predictors of LVA. A total of 34 (12.1%) patients developed LVA at one-year follow-up after pPCI. Multivariate analyses revealed that a 10 × 109/L increase in platelet count 12 h after pPCI (odds ratio [OR] 1.092, 95% confidence interval [CI] 1.015-1.188, p = 0.039), peak cardiac troponin I (OR 1.107, 95% CI 1.003-1.215, p = 0.000), and left ventricular ejection fraction (OR 0.853, 95% CI 0.772-0.943, p = 0.002) were independent risk factors for LVA. For the prediction of LVA, platelet count 12 h after pPCI at a cut-off value > 197 × 109/L yielded a receiver operating characteristic-area under the curve (ROC-AUC) of 0.635 (82.3% sensitivity, 44.1% specificity). Platelet count after pPCI was significantly associated with the development of LVA in anterior STEMI patients and may be available for early risk stratification of future LVA formation.

Recognition, assessment and management of the mechanical complications of acute myocardial infarction

### Learning objectives Mechanical complications post-acute myocardial infarctions (AMIs) are rare, but may have dramatic and potentially lethal consequences. Most often, the left ventricle is affected and complications are classified...