Abstract
507
Objectives The aim of this study was (1) to evaluate the prognostic value of left ventricular (LV) remodeling parameters in patients with LV aneurysm(LVA) assessed by different noninvasive imaging modalities, including 99mTc-MIBI gated SPECT myocardial perfusion imaging (GSPECT), 18F-FDG gated metabolic PET imaging (GPET), cardiac magnetic resonance imaging (CMR) and echocardiography in patients with LVA; (2) impact of myocardial viability, LV remodeling, and interaction between myocardial viability and LV remodeling on the long-term survival in patients with LVA.
Methods One hundred and twenty-six consecutive LVA patients (111 male, mean ages of 56 ±10 years) determined by CMR who underwent GSPECT, GPET and CMR, echocardiography within two weeks were retrospectively enrolled. Cardiac death during follow-up was served as the endpoint. LV ejection fraction (LVEF, %), end-diastolic volume (EDV, mL) and end-systolic volume (ESV, mL) were measured by GSPECT, GPET, and CMR. Further, EDV and ESV were corrected by body surface area, then, EDVI (mL/m2) and ESVI (mL/m2) were obtained. Aneurysmal viability were defined if perfusion-metabolism mismatch score 蠅 2.0. Cardiac survival curves were generated by the Kaplan-Meier method and compared by the log-rank test.
Results After a mean follow-up of 3.9 ± 1.5 years (median 4.1 years), 21(16.7%) patients suffered from cardiac death. Univariate Cox hazard regression analysis showed that sex, age, BMI, NYHA, LVEF measured by GPET, both EDV and ESV measured by GPET and CMR, ESV measured by GSPECT, summed rest score in aneurysm region, aneurysmal viability, interaction between aneurysmal viability and ESV were independent predictors for cardiac death, respectively (all P value < 0.05) , while ESV-GPET (HR 1.014, 95% CI:1.005~1.022, P = 0.001) and aneurysmal viability (HR 6.48, 95% CI: 2.13~19.72, P = 0.001) were independent predictors for cardiac death by multivariate Cox analysis. In addition, if remodeling parameters of EDV and ESV were replaced by EDVI and ESVI, interaction between ESVI-PET and aneurysmal viability (HR 1.021, 95% CI: 1.008 -1.033, P =0.001), and ESVI-PET (HR 1.021, 95% CI: 1.007 -1.035, P =0.004) were independent predictors for cardiac death by multivariate Cox analysis. Therefore, patients were divided into four groups according to aneurysmal viability and LV remodeling (ESVI-PET>60 mL/m2). Group 1 (n = 49, 38.9%): viability-, LV remodeling-; Group 2 (n = 38, 30.2%): viability-, LV remodeling+; Group 3 (n =23, 18.3%): viability+, LV remodeling-; Group 4 (n = 16, 12.7%): viability+, LV remodeling+. Annual cardiac mortality rate in Group 1 (0.5%) was the lowest, which was significant lower than that in groups 3 (7.8%, χ2 = 7.0, P = 0.008) and 4 (9. 6%, χ2 = 19.3, P < 0.0001). Annual cardiac mortality rate of patients in group 2 (4.7%) had a trend to be lower than that in group 4 (P =0.087), but no significant difference. Finally, in comparison with medical therapy, revascularization did not significantly impact the long-term survival in groups 1 (95.5% vs.100%, respectively, P=0.257) and 2 (83.3% vs. 80.8%, respectively, P=0.799). On the other hand, revascularization had a trend to improve the long-term survival in groups 3 (83.3% vs. 54.5%, respectively, P=0.089) and 4 (87.5% vs. 37.5%, respectively, P =0.062), but no significant difference.
Conclusions Among LV remodeling parameters measured by different imaging modalities, ESVI-PET had the highest predictor value for cardiac death. LVA patients with severe LV remodeling and myocardial viability were at high risk for cardiac death, and revascularization could improve the long-term survival. In contrast, the long-term survival of patients without LV remodeling and without aneurysmal viability was promising (5-year survival>95%).
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