What does this research mean for the field?

Surgical treatment of post-myocardial infarction left ventricular aneurysm, including aneurysmectomy and revascularization, significantly improves left ventricular diastolic performance and residual myocardial viability compared to non-surgical medical therapy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

January 1, 1985Open Access

Study of left ventricular function and myocardial viability in patients with left ventricular aneurysm developed after myocardial infarction A comparative study of medical and surgical therapy.

YYYoshimasa YabeJikei University School of Medicine TYToshiharu YamashitaUniversity of Tsukuba HKHisashi KOMATSUNagoya University

Structured PICO

Does surgical treatment (aneurysmectomy) improve left ventricular function and myocardial viability compared to medical therapy in patients with left ventricular aneurysm after myocardial infarction?

Population

44 patients with left ventricular aneurysm (LVA) developed after myocardial infarction showing cineangiographical features of LVA, mean age 59.2, 43 males, Japan-based.

Intervention

Surgical treatment (aneurysmectomy, with or without aortocoronary bypass graft)

Comparator

Non-surgical (medical) treatment

Outcome

Left ventricular function and myocardial viability (including EF, LVEDP, LVEDV, wall stress, and residual myocardial motion) at 1 year restudysurrogate

Aneurysmectomy or concomitant myocardial revascularization with aneurysmectomy improves left ventricular diastolic performance and increases residual myocardial viability compared to medical therapy in patients with post-infarction left ventricular aneurysm.

Abstract

We evaluated the treatment of left ventricular aneurysm (LVA) caused by myocardial infarction in 44 patients showing cineangiographical features of left ventricular aneurysm. Of the 44 patients, 28 were treated non-surgically (N-S) and 16 were treated surgically (S). Combined aortocoronary bypass graft (ACBG) with aneurysmectomy was performed on 10 patients. Clinical symptoms in LVA patients were angina (34%), congestive heart failure (31.8%), arrhythmia (29.5%), mitral regurgitation (9%), embolism (4%) and septal perforation (2.3%). Distribution of coronary arterial lesions were single vessel (isolated LAD) 29.5% and multiple vessel 59%. Parameters of LV performance measured at baseline in all LVA patients were: CI 3.05 +/- 0.64 L/min/m2, LVEDP 19.0 +/- 3.5 mmHg, LVEDV 200.6 +/- 25.9 ml, diast. wall stress 50.7 +/- 16.8 g/cm2, EF 0.46 +/- 0.15, LV dp/dt/p 17.8 +/- 2.1 S-1, SWI 61 +/- 24 gm/m2. LV performance after surgery showed clear decreases in LVEDP, LVEDV and wall stress (p less than 0.05, p less than 0.02 and p less than 0.02, respectively). In contrast, EF, LV dp/dt/p and SWI increased significantly (p less than 0.02, p less than 0.1 and p less than 0.01, respectively). Comparison of the results of restudy with first catheterization data in the N-S group showed decreases of EF, contractility index and LV dp/dt/p, each reaching p less than 0.1. Residual myocardial motion 1 year after the first cineangiographic study showed a significant decrease (-12.8 +/- 26.7%) in the N-S group, whereas in the S group it significantly increased to (+60.4 +/- 52.7%). A significant difference in coefficient of variation between N-S and S groups was found. Thus, it can be concluded that aneurysmectomy or concomitant myocardial revascularization with aneurysmectomy improves left ventricular diastolic performance and increases residual myocardial viability.

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