Left ventricular aneurysm as a coronary risk factor independent of overall left ventricular function.

Patients with left ventricular aneurysm (LVA) have been shown to have a higher mortality rate than those with normal left ventricular function. The purpose of this study was to determine whether or not LVA, in patients with coronary artery disease, is a risk factor independent of left ventricular function. Thirty-nine patients with angiographically demonstrated segmental dyskinesis (LVA group) were retrospectively compared to 28 patients with segmental akinesis and ejection fraction less than 60% (control group). There was no significant difference in age, ejection fraction, severity of coronary artery disease, cardiac index, or frequency of cardiac surgery between the two groups. Compared to control subjects, the LVA group had a significantly higher left ventricular end-diastolic pressure and greater tendency to have apical involvement. Although electrocardiography, echocardiography, and radioventriculography were each highly specific, their sensitivities were only 40% to 60%. Follow-up data were available for a mean of 33 months after catheterization. No significant benefit from aneurysmectomy could be demonstrated. There was an insignificant trend in the LVA group toward more severe congestive heart failure and less angina. There was no significant difference in the reinfarction rate, incidence of ventricular tachycardia, or embolism. Mortality rate was 38% in the LVA group and 32% in the control group (p = 0.59). We conclude that LVA is not an independent risk factor for congestive heart failure, angina, ventricular tachycardia, reinfarction, embolism, or death.