Key result
Basal LV aneurysms show higher diastolic sphericity index vs apical aneurysms, driven by shorter long axes.
Why the study?
Left ventricular aneurysm causes geometric remodeling quantified by the sphericity index, but its value across apical versus basal aneurysm locations, influencing factors, and clinical relevance needed assessment.
Does the sphericity index on echocardiography differentiate apical from basal left ventricular aneurysms in post-infarction patients?
Observational (n=54)
No
Does the sphericity index on echocardiography differentiate apical from basal left ventricular aneurysms in post-infarction patients?
The sphericity index is a valuable echocardiographic marker that differentiates basal from apical post-infarction aneurysms, revealing that basal aneurysms lead to a more spherical ventricular shape, which is further exacerbated by severe mitral regurgitation.
Sphericity index may differentiate basal from apical post-infarction aneurysms on echo; leaves open its prognostic or therapeutic role pending prospective validation.
Background and Objectives: Left ventricular aneurysm (LVA) causes geometric changes, including reduced systolic function and a more spherical shape, which is quantified by the sphericity index (SI), the ratio of the short to long axis in the apical four-chamber view. This study aimed to assess SI’s value in A-LVA and B-LVA, identify influencing factors, and evaluate its clinical relevance. Materials and Methods: This clinical study included 54 patients with post-infarction LVA and used echocardiography to determine LVA locations (A-LVA near the apex and B-LVA in the basal segments), with SI and other echocardiographic measures assessed in both systole and diastole for the entire cohort and stratified by A-LVA and B-LVA groups. Results: Among the 54 patients, 41 had A-LVA and 13 had B-LVA. The mean SI was 0.55 in diastole and 0.47 in systole for the cohort. Patients with A-LVA had a mean SI of 0.51 in diastole and 0.44 in systole, while B-LVA patients exhibited significantly higher SI values, with 0.65 in diastole and 0.57 in systole, due to lower long-axis (L) values in both phases. The mean left ventricular ejection fraction (EF) was 23.95% in A-LVA and 30.85% in B-LVA, with no significant difference. However, apical aneurysms were larger (greater LVAV and LVAA) and more significantly reduced functional myocardium. LVEDV, LVESV, LVEDA, and LVESA did not differ significantly between A-LVA and B-LVA. In cases of severe mitral regurgitation (MR), SI was notably higher (0.75 in diastole) due to a marked reduction in the L axis. Conclusions: SI is key in differentiating A-LVA and B-LVA on echocardiography. B-LVA has lower volume and area values, but similar aneurysm and left ventricular volumes and EF. Higher SI in B-LVA is due to a reduced L-axis, and is worsened by severe mitral regurgitation (MR). Surgical ventricular reconstruction (SVR) compensates for L-axis reduction, with preservation of the L axis critical for achieving a more physiological shape. SI thus serves as a marker for left ventricular geometry and surgical outcomes.
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Tomić et al. (2025) conducted an observational in Post-infarction left ventricular aneurysm (LVA) (n=54). Basal left ventricular aneurysm (B-LVA) vs. Apical left ventricular aneurysm (A-LVA) was evaluated on Sphericity index (SI) in diastole. Basal left ventricular aneurysms exhibited a significantly higher diastolic sphericity index (0.65) compared to apical aneurysms (0.51) due to reduced long-axis dimensions.
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