Scintiphotographic Evaluation of Patients with Suspected Left Ventricular Aneurysm

Twenty-two patients with a history of myocardial infarction and suspected of having a left ventricular aneurysm were evaluated by routine clinical studies, gated cardiac blood pool scanning, and contrast left ventriculography. Thirteen patients were found to have a localized left ventricular aneurysm and nine demonstrated diffuse left ventricular hypokinesis on contrast angiography. The patients with localized left ventricular aneurysms could not be separated from those with diffuse left ventricular hypokinesis on the basis of the routine clinical evaluation including the chest roentgenogram or the finding of ST-segment elevation in the electrocardiogram. Scintiphotographic studies identified the nine with diffuse hypokinesis and twelve of the thirteen with a localized left ventricular aneurysm. In one patient with a calcified left ventricular aneurysm filled with clot, the cardiac blood pool scan showed an area of akinesis which corresponded to that seen on contrast angiography, but the aneurysm could not be detected. In nineteen of the patients in whom adequate measurements were obtained, left ventricular end-diastolic volume and ejection fraction by both contrast angiography and gated cardiac blood pool scintiphotography demonstrated a good correlation, r = 0.92 and 0.87, respectively. There was also a good correlation between the extent of left ventricular akinesis seen on contrast angiography and gated scintiphotography, r = 0.97. This study demonstrates that biplane gated cardiac blood pool scans are useful in differentiating patients with localized left ventricular aneurysms from those with diffuse left ventricular hypokinesis.