Left Ventricular Aneurysm Group Research Articles

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.

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.

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.

Aneurysm-related ischemic ventricular tachycardia: safety and efficacy of catheter ablation.

Left ventricular aneurysm (LVA) postmyocardial infarction (MI) might be an arrhythmogenic substrate. We examined the safety and efficacy of catheter ablation of LVA-related ventricular tachycardia (VT).Thirty-three consecutive patients who underwent primary catheter ablation of ischemic VT were divided into LVA group (11 patients, mean age 61.9 years, 10 men) and none LVA group. Acute procedural outcomes, complications, and long-term outcomes were assessed.In LVA group, average number of induced VTs were 3.2 ± 2.6 (range 1–7), clinical VTs were located in the ventricular septum scar zone in 4 (36.4%) patients, acute success was achieved in 7 (63.6%) patients, partial success in 3 (27.3%) and failure in 1 patient, while none LVA group showing a statistically similar distribution of acute procedural outcomes (P = 0.52). There were no major or life-threatening complications. VT-free survival rate at median 19 (1–44) months follow-up was numerically but not significantly lower in LVA versus none LVA group (48.5% vs 62.8%, log-rank P = 0.40).Catheter ablation of ischemic VT in the presence of LVA appears feasible and effective, with about one-third of cases having septal ablation targets. Further studies are warranted.

The value of myocardial torsion and aneurysm volume for evaluating cardiac function in rabbit with left ventricular aneurysm.

ObjectiveThis study aimed to investigate the effect of left ventricular aneurysm (LVA) volume and left ventricular global torsion on cardiac function by real time three-dimensional echocardiography (RT-3DE) and two-dimensional speckle tracking imaging(2D-STI), to determine the accuracy of RT-3DE and 2D-STI in assessing LV function.MethodsThirty New Zealand rabbit models of with LVA were prepared by ligation of the middle segment of the left anterior descending and left circumflex arteries. Four weeks post-procedure, RT-3DE was conducted to obtain data on LVEF, left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), and LVA volume (LVAV), Peak rotation angles at the mitral valve annulus level (MV-ROT), peak rotation angles at the apical level (AP-ROT), and left ventricular global torsion angles (LV-TOR) were measured by 2D-STI.ResultsCompared with controls, LVEDV and LVESV were significantly increased in the LVA group, while LVEF, MV-ROT, AP-ROT, and LV-TOR were consistently reduced (p<0.01). Moreover, LVEF correlated with LVA volume and LV torsion angle (r= -0.778 and 0.821, p<0.01). LVA volume/LVEDV had the strongest inverse relationship with LVEF (r= -0.911, p<0.01).ConclusionLVA volume, LVA volume/LVEDV, and LV torsion may be used as an indicator for evaluation of cardiac function after LVA. Moreover, LVA volume/LVEDV may be a more sensitive and reliable marker of cardiac function after LVA formation.

Characteristics and outcome of congenital left ventricular aneurysm and diverticulum: Analysis of 809 cases published since 1816

BackgroundCongenital left ventricular aneurysm (LVA) or diverticulum (LVD) is rare cardiac anomalies. We aimed to analyse the clinical characteristics and outcome in all ever published patients. MethodsMEDLINE, Web of science, Google and EMBASE, and reference lists of relevant articles were searched for publications reporting on LVA or LVD patients. ResultsWe identified 809 patients published since 1816 [354 (49.1%) LVA, 453 (50.6%) LVD, 2 (0.3%) both]. Mean age at diagnosis was 34.1±27 (LVA) and 29.7±27.6years (LVD; p=0.05). 48.9% were male. LVA was larger (38.7±22.5mm versus 31.4±21.2mm; p=0.002) and frequently found in submitral location (33% versus 4.9%; p<0.001), LVD was frequently located at the LV-apex (61.2% versus 28.7%; p<0.001). LVD was often associated with cardiac (34.2% versus 11%; p<0.001) or extracardiac anomalies (32.7% versus 3%; p<0.001). LVA patients presented more frequently with ventricular tachycardia/fibrillation (18.1% versus 13.1%; p=0.01), the incidences of rupture (4% versus 4.5%; p=0.9), syncope (8.3% versus 5.1%; p=0.1), and embolic events (4.9% versus 3.6%; p=0.4) at presentation were not different between LVA and LVD.Mean follow-up was 56.3±43months. Cardiac death occurred more frequently in the LVA group (11.5% versus 5.0%; p=0.05) at a median age of 0.8 [LVA] and 2.5 [LVD] years. The leading cause of cardiac death was congestive heart failure in the LVA-group (50.0% versus 0.0%; p=0.01), and rupture in the LVD-group (75.0% versus 27.3%; p=0.04). ConclusionsLVA and LVD are distinct congenital anomalies with different clinical and morphological characteristics. The prognosis of LVA is significantly worse during long-term follow-up.

Assessment of risk factors for patients with anatomical left ventricular aneurysm post acute ST-elevation myocardial infarction by use of multiple-risk-factor assessment models

To set up the multiple risk factors model of patients with anatomical left ventricular aneurysm (LVA) post acute ST-elevation myocardial infarction (STEMI) and quantitatively assess the pathopoiesis of all the factors. A total of 518 consecutive inpatients with acute STEMI hospitalized from June 2010 to December 2013 in our hospital were enrolled in this study, patients were divided into two groups: LVA group (n = 106, 20.5%) and non-LVA group (n = 412, 79.5%). All demographic and clinical data were collected by cardiologists. Finally, all of the risk factors for anatomical LVA in the acute STEMI patients were quantitatively analyzed by a binary logistic regression model. The multiple risk factors logistic regression model was set up for the anatomical LVA in patients with acute STEMI. Anterior wall myocardial infarction, occlusion of the left anterior descending branch, two or three vessels stenosis, high systolic blood pressure, sinus tachycardia and white blood cell count over 10 000 per microliter were all independent risk factors of the LVA in acute STEMI, with the odds ratio (OR) 18.21, 21.56, 4.22, 7.16, 1.98 and 1.57, respectively (all P < 0.05) . However, first medical contact less than 12 hours (OR = 0.60), collateral circulation of the coronary arteries(OR = 0.53), primary percutanous coronary intervention(OR = 0.23) and venous thrombolysis(OR = 0.12) were all protecting factors of the LVA in acute STEMI patients (all P < 0.05). Anterior wall STEMI, occlusion of the left anterior descending branch, two or three vessels stenosis, high systolic blood pressure, sinus tachycardia and white blood cell count over 10 000 per microlitre are independent risk factors of the LVA in acute STEMI patients. However, first medical contact less than twelve hours, collateral circulation of the coronary arteries, together with the primary percutanous coronary intervention and venous thrombolysis are protective factors of the LVA in patients with acute STEMI. It is important for cardiologists to assess the risks of LVA and make emergent and suitable efforts to reduce the risk of developing LVA in STEMI patients.

GW24-e1717 Assessment on the changes of myocardial strain rate and aneurysm volume of left ventricular aneurysm in a rabbit model

ObjectivesThe aim of this study was to evaluate the changes of myocardial strain Rate and Aneurysm volume and the effect of left ventricular aneurysm (LVA) volume and myocardial strain on...

The Value of Aneurysm Volume and Myocardial Strain Rate for Evaluating Cardiac Function of Ischemia‐Related Left Ventricular Aneurysm in a Rabbit Model Using Real Time Three‐Dimensional Echocardiographic Imaging Combined with Speckle Tracking Imaging

The aim of this study was to evaluate the effect of left ventricular aneurysm (LVA) volume and myocardial strain on left ventricular function in a rabbit model using real time three-dimensional echocardiographic imaging (RT-3DE) combined with two-dimensional speckle tracking imaging (2D-STI). A rabbit model of LVA was prepared in 30 New Zealand rabbits by ligating the middle segment of the left anterior descending artery and the left circumflex artery (LVA group); 10 control rabbits underwent thoracotomy alone. Four weeks later, RT-3DE was performed to obtain data on left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), and LVA volume. The peak short-axis radial (SrR) and circumferential (SrC) strain rates were measured using 2D-STI technique. Compared with control rabbits, LVA group rabbits had significant left ventricular enlargement at the end-systolic and end-diastolic phases (both P < 0.05). LVEF, SrR-Systolic, and SrC-Systolic were significantly lower in the LVA group (all P < 0.05). Moreover, there were high correlations between LVEF and SrC-Systolic anterior wall, SrR-Systolic anterior wall, SrC-Systolic lateral wall, and SrR-Systolic lateral wall (r = -0.895, -0.887, -0.890, -0.891, respectively, all P < 0.05). Of note, LVA volume/LVEDV had the tightest inverse relationship with LVEF (r = -0.911, P < 0.01). Specifically, LVA volume/LVEDV >16% corresponded to LVEF <50%, and LVEF decreased 1.1% while LVA volume/LVEDV increased 1%. LVA volume/LVEDV provided a sensitive indicator reflecting cardiac function with LVA. Measurement of various parameters using RT-3DE might be a useful means to evaluate cardiac function after LVA formation.

E0653 Level change of plasma BNP and the relationships to the left ventricular aneurysm formation and cardiac performance in patients with acute myocardial infarction

ObjectiveTo investigate the change of brain natriuretic peptide (BNP) in plasma and the relationships with the left ventricular aneurysm (LVA) and cardiac performance in acute myocardial infarction (AMI) patients using...

E0652 The level changes of IL-8 and the relationship to the left ventricular aneurysm formation and cardiac performance in patients with acute myocardial infarction

ObjectiveTo investigate the changes in interleukin-8 (IL-8) and the relationship with the left ventricular aneurysm (LVA) and cardiac function in acute myocardial infarction (AMI) patients using left ventriculography (LVG).MethodsA total...

An Ultrastructural Study of Cardiac Myocytes in Postmyocardial Infarction Ventricular Aneurysm Representative of Chronic Ischemic Myocardium Using Semiquantitative and Quantitative Assessment

To elucidate the characteristic myocytic changes in chronic ischemic myocardium, an electronmicroscopic (EM) study was carried out in surgically excised postmyocardial infarction left ventricular aneurysm (LVAN) ( n = 15) using semiquantitative (in all 15 cases) and quantitative assessment methods (in 10 cases). The control group, representing normal ultrastructure, included left ventricular endomyocardial biopsy specimens of sick sinus syndrome (SSS) ( n = 3), Wolff-Parkinson-White (WPW) Syndrome ( n = 1), and intraoperative left ventricular endomyocardial biopsy in mitral stenosis (MS) ( n = 3). Myocardial condition was assessed at the ultrastructural level according to the severity of morphologic changes, first semiquantitatively, thereafter with the use of the Image Processor-Analyzer LUZEX III for morphometric analysis. The most marked EM findings were mitochondrial regressive changes, glycogen accumulation, nuclear deformities, increased rough-surfaced endoplasmic reticulum at the perinuclear portion, lysis of myofibrils, and myofibrillar degeneration. The quantitative analysis revealed significant ( p < 0.05) increase of glycogen deposition, only at the perinuclear portion in the LVAN group. The myofibril to mitochondria ratio at the intercalated disc (ID) portion of the cardiac myocytes significantly increased ( p < 0.01) in the LVAN group as compared with the normal control group. Light microscopically evaluated quantitative analysis, using toluidine-blue stained semithin sections which underwent EM observation, showed that the fractional area of interstitial fibrous tissue was significantly increased in the LVAN group compared to the normal controls ( p < 0.01). These results signify that in chronic ischemic myocardium, decreased consumption of glycogen in oxidative phosphorylation occurs in the surviving myocytes, and that hypertrophy of the myocytes appears. The results of this study may lead to the proper ultrastructural interpretation of biopsied human myocardium, regardless of etiology.

Effect of left ventricular aneurysm on risk of sudden and nonsudden cardiac death

Although left ventricular (LV) aneurysm is associated with increased mortality, its independent prognostic significance is controversial. To determine the effect of LV aneurysm on risk, 121 patients with healed myocardial infarction (MI), 55 manifesting akinesia on ventriculography (MI group) and 66 with LV aneurysm characterized by diastolic deformity (eccentricity) and systolic dyskinesia (LV aneurysm group) were studied. At a mean follow-up of 5.7 years, there were 32 cardiac deaths (12 MI vs 20 LV aneurysm), including 9 sudden deaths (1 MI vs 8 LV aneurysm). Multivariate analysis revealed decreasing ejection fraction to be the best predictor of total cardiac death, and revascularization to be protective. Nonsudden cardiac death was predicted by ejection fraction, absence of revascularization and right coronary artery disease, whereas sudden cardiac death was predicted by LV aneurysm and the frequency of ventricular ectopic complexes on Holter monitoring. In the MI group, ejection fraction was the only significant predictor of total cardiac death and nonsudden cardiac death. In the LV aneurysm group, total cardiac death, as well as nonsudden cardiac death, were predicted by ejection fraction, ventricular tachycardia and right coronary artery disease, whereas ventricular tachycardia predicted sudden cardiac death. It is concluded that the risk profile for total cardiac death differs between LV aneurysm and MI patients, and that LV aneurysm constitutes an independent predictor of late sudden cardiac death after MI. Moreover, on a substrate of LV aneurysm, the risk factors for sudden cardiac death and nonsudden cardiac death differ, with ventricular tachycardia being the sole predictor of sudden cardiac death. Furthermore, Holter monitoring is valuable in Identifying patients at persistent risk of sudden cardiac death.

Left ventricular aneurysm as a coronary risk factor independent of overall left ventricular function

Patients with left ventricular aneurysm (LVA) have been shown to have a higher mortality rate than those with normal left ventricular function. The purpose of this study was to determine whether or not LVA, in patients with coronary artery disease, is a risk factor independent of left ventricular function. Thirty-nine patients with angiographically demonstrated segmental dyskinesis (LVA group) were retrospectively compared to 28 patients with segmental akinesis and ejection fraction less than 60% (control group). There was no significant difference in age, ejection fraction, severity of coronary artery disease, cardiac index, or frequency of cardiac surgery between the two groups. Compared to control subjects, the LVA group had a significantly higher left ventricular end-diastolic pressure and greater tendency to have apical involvement. Although electrocardiography, echocardiography, and radioventriculography were each highly specific, their sensitivities were only 40% to 60%. Follow-up data were available for a mean of 33 months after catheterization. No significant benefit from aneurysmectomy could be demonstrated. There was an insignificant trend in the LVA group toward more severe congestive heart failure and less angina. There was no significant difference in the reinfarction rate, incidence of ventricular tachycardia, or embolism. Mortality rate was 38% in the LVA group and 32% in the control group ( p = 0.59). We conclude that LVA is not an independent risk factor for congestive heart failure, angina, ventricular tachycardia, reinfarction, embolism, or death.