Akinetic versus dyskinetic left ventricular aneurysms diagnosed by gated scintigraphy: difference in surgical outcome

Abstract

Forty-one patients selected for left ventricular aneurysm resection and coronary artery bypass grafting were studied by gated radionuclide ventriculography, and right heart catheterization before and after operation to establish whether the presence of paradoxically systolic expansion, as defined by radionuclide ventriculography, influenced the surgical outcome. Patients with systolic paradoxically moving left ventricular aneurysms (n = 28) improved their functional classification (New York Heart Association) (p less than 0.01) and exercise tolerance (watt-minutes) (p less than 0.001) compared with preoperative values, in contrast to the patients with akinetic aneurysms (n = 13), whose status remained unchanged. Left ventricular ejection fraction at rest (p less than 0.001) and exercise (p less than 0.0001) improved along with a significant reduction in left ventricular end-diastolic (p less than 0.002) and end-systolic volume indices (p less than 0.001) among the patients with paradoxical left ventricular aneurysms versus no change in the akinetic group. In a multivariate analysis of different preoperative variables, the presence of dyskinesia was found to be the only independent predictor of a favorable surgical outcome (p less than 0.004). In conclusion, the presence of dyskinesia represents an important marker of the outcome after aneurysmectomy.