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The Influence of Apical Aneurysm on Left Ventricular Geometry and Clinical Outcomes: 3‐Year Follow‐Up Using Echocardiography
Author(s) -
Jung MiHyang,
Youn HoJoong,
Jung Hae Ok
Publication year - 2016
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13188
Subject(s) - medicine , hazard ratio , cardiology , ejection fraction , confidence interval , myocardial infarction , adverse effect , heart failure , proportional hazards model , aneurysm , surgery
Background 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. Methods 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. Results 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. Conclusions This study demonstrates that LVAA s undergo a dynamic process and that large LVAA s are associated with adverse outcomes. Our results suggest that the ACR could be helpful for predicting adverse outcomes in patients with apical aneurysm.