Jung Mi-Hyang, Youn Ho-Joong, Jung Hae Ok
Cardiovascular Center, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
Echocardiography. 2016 Jun;33(6):814-20. doi: 10.1111/echo.13188. Epub 2016 Jan 27.
Left ventricular apical aneurysm (LVAA) is a serious complication associated with myocardial infarction. However, the effects of a previously formed LVAA on long-term left ventricular (LV) geometry and clinical outcomes have not been fully evaluated.
From January 2009 to May 2015, we retrospectively identified 70 patients (mean age, 66 ± 12 years; males, 72.9%) with an LVAA due to ischemia. These patients were classified into two groups according to the initial apical conicity ratio (ACR): large LVAA group (ACR ≥ 1.5, n = 40) and small LVAA group (ACR < 1.5, n = 30). An adverse outcome was defined as a composite of fatal arrhythmia, embolic infarction, and readmission due to heart failure.
The ACR significantly decreased over the first month and then increased after 1 and 3 years of follow-up. The other examined echocardiographic indexes did not exhibit temporal changes. During the follow-up period (median 1138 days), the large LVAA group experienced a lower event-free survival (P = 0.016). In a multivariate Cox model, the presence of a large LVAA (adjusted hazard ratio [HR] = 2.795, 95% confidence interval [CI] = 1.118-6.986, P = 0.028) and the initial LV ejection fraction (EF) (adjusted HR = 0.964, 95% CI = 0.932-0.997, P = 0.034) were independent predictors of adverse outcomes.
This study demonstrates that LVAAs undergo a dynamic process and that large LVAAs are associated with adverse outcomes. Our results suggest that the ACR could be helpful for predicting adverse outcomes in patients with apical aneurysm.
左心室心尖部动脉瘤（LVAA）是心肌梗死相关的严重并发症。然而，先前形成的LVAA对长期左心室（LV）几何形态及临床结局的影响尚未得到充分评估。
2009年1月至2015年5月，我们回顾性纳入70例因缺血性病因导致LVAA的患者（平均年龄66±12岁；男性占72.9%）。根据初始心尖部锥度比（ACR）将这些患者分为两组：大LVAA组（ACR≥1.5，n = 40）和小LVAA组（ACR<1.5，n = 30）。不良结局定义为致命性心律失常、栓塞性梗死及因心力衰竭再次入院的复合情况。
ACR在随访的第1个月显著降低，随后在1年和3年后升高。其他检查的超声心动图指标未呈现时间变化。在随访期（中位时间1138天），大LVAA组无事件生存率较低（P = 0.016）。在多因素Cox模型中，大LVAA的存在（调整后风险比[HR]=2.795，95%置信区间[CI]=1.118 - 6.986，P = 0.028）及初始左心室射血分数（EF）（调整后HR = 0.964，95%CI = 0.932 - 0.997，P = 0.034）是不良结局的独立预测因素。
本研究表明LVAA经历一个动态过程，且大LVAA与不良结局相关。我们的结果提示ACR可能有助于预测心尖部动脉瘤患者的不良结局。
