Tomić Slobodan, Veljković Stefan, Šljivo Armin, Radoičić Dragana, Lončar Goran, Bojić Milovan
Cardiovascular Institute ''Dedinje'', 11040 Belgrade, Serbia.
Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina.
Medicina (Kaunas). 2025 Jan 3;61(1):68. doi: 10.3390/medicina61010068.
: 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. : 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. : 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. : 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.
左心室室壁瘤（LVA）会引起几何形状改变，包括收缩功能降低和形状更趋球形，这可通过球形指数（SI）来量化，即心尖四腔心切面短轴与长轴之比。本研究旨在评估SI在A型左心室室壁瘤（A-LVA）和B型左心室室壁瘤（B-LVA）中的价值，确定影响因素，并评估其临床相关性。：这项临床研究纳入了54例心肌梗死后左心室室壁瘤患者，采用超声心动图确定左心室室壁瘤的位置（心尖附近的A-LVA和基底节段的B-LVA），对整个队列在收缩期和舒张期评估SI及其他超声心动图指标，并按A-LVA和B-LVA组进行分层。：在这54例患者中，41例为A-LVA，13例为B-LVA。整个队列舒张期平均SI为0.55，收缩期为0.47。A-LVA患者舒张期平均SI为0.51，收缩期为0.44，而B-LVA患者的SI值显著更高，舒张期为0.65，收缩期为0.57，这是因为两个阶段的长轴（L）值较低。A-LVA患者平均左心室射血分数（EF）为23.95%，B-LVA患者为30.85%，无显著差异。然而，心尖部室壁瘤更大（左心室室壁瘤体积和左心室动脉瘤面积更大），功能性心肌减少更显著。A-LVA和B-LVA之间左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）、左心室舒张末期面积（LVEDA）和左心室收缩末期面积（LVESA）无显著差异。在严重二尖瓣反流（MR）的情况下，由于L轴显著缩短，SI明显更高（舒张期为0.75）。：在超声心动图上，SI是区分A-LVA和B-LVA的关键。B-LVA的容积和面积值较低，但室壁瘤和左心室容积及EF相似。B-LVA中较高的SI是由于L轴缩短，严重二尖瓣反流（MR）会使其恶化。手术心室重建（SVR）可弥补L轴缩短，保留L轴对于实现更接近生理形状至关重要。因此，SI可作为左心室几何形状和手术结果的标志物。
