Left ventricular aneurysm and the prediction of left ventricular enlargement studied by two-dimensional echocardiography: Quantitative assessment of aneurysm size in relation to clinical course

Abstract

A retrospective study was performed to elucidate the process of left ventricular aneurysm formation and its influence on left ventricular enlargement based on serial two-dimensional echocardiographic observations from 150 consecutive patients with first acute anterior myocardial infarction. Echocardiograms were available and interpretable through the entire period of observation in 68 patients. Because of early death in 13 patients, echocardiograms of 55 patients 22 with and 33 without aneurysm, were analyzed from 1 to 28 days after infarction. Patients with aneurysms were separated into two groups with large (group 1, 11 patients) and small aneurysms (group 2, 11 patients) on the basis of ratios of aneurysm to overall left ventricular circumferential length [Lcf-LV(RAO)] and area [Area-LV(RAO)], i.e., Lcf(An/LV)-RAO and Area(An/LV)-RAO, respectively, in the right anterior oblique equivalent view at the time of aneurysm formation, with reference to Forrester's subset. Group 1 consisted of patients with Lcf(An/LV)-RAO of 0.4 or greater or Area(An/LV)RAO of 0.3 or greater while group 2 included patients with Lcf(An/LV)-RAO less than 0.4 or Area(An/LV)-RAO less than 0.3. In the test for time trend in these groups with a one-way analysis of variance, Lcf-LV in RAO equivalent and apical four-chamber views and Area-LV in apical four-chamber view effectively separated group 1 from groups 2 and 3 (without aneurysm) with significance (p < .005, p < .01, and p < .01). In group 1 the incidence of heart failure was significantly higher than that in groups 2 and 3 (77.8% vs 0% and 21.1%; p < .001, p < .001), and the mortality was high compared with that of the other two groups (38.7% vs 8.3% and 13.2%) showing statistical significance only with group 3 (p < .05). The present criteria for separating patients with left ventricular aneurysm seem useful in predicting future left ventricular enlargement and developing clinical prognosis even at the time of aneurysm formation.