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. 2021 Mar;26(2):e12814.
doi: 10.1111/anec.12814. Epub 2020 Dec 24.

Impact of revascularization in patients with post-infarction left ventricular aneurysm and ventricular tachyarrhythmia

Xiaohui Ning  1 , Zihe Yang  2 , Xuerui Ye  1 , Yanhua Si  1 , Fang Wang  1 , Xiaoli Zhang  2 , Shu Zhang  1
Affiliations

Impact of revascularization in patients with post-infarction left ventricular aneurysm and ventricular tachyarrhythmia

Xiaohui Ning et al. Ann Noninvasive Electrocardiol. 2021 Mar.

Abstract

Background: Ventricular arrhythmia is a leading cause of cardiac death among patients with post-infarction left ventricular aneurysm (PI-LVA). The effect of coronary revascularization in PI-LVA patients with ventricular tachyarrhythmia remains unknown. This study aims to investigate the impact of revascularization therapy on clinical outcomes in these patients.

Methods: A total of 238 PI-LVA patients were enrolled, and 59 patients were presented with sustained ventricular tachycardia (VT) or ventricular fibrillation (VF). Patients were classified into 4 groups by treatment strategies (medical or revascularization) and the presence of VT/VF: group 1 (n = 57): VT/VF- and revascularization-; group 2 (n = 122): VT/VF- and revascularization+; group 3 (n = 34): VT/VF+ and revascularization+; and group 4 (n = 25): VT/VF+ and revascularization-. The clinical outcomes were compared, and the primary endpoint was cardiac death or heart transplantation.

Results: Patients were followed up for 45 ± 16 months, and 41 patients (17.2%) reached the primary endpoint. Kaplan-Meier analysis showed that in VT/VF- patients, revascularization associated with higher cardiac survival compared with medical therapy (log-rank p = .002), but in VT/VF+ patients, revascularization did not predict better cardiac outcome (log-rank p = .901). Cox regression analysis revealed PET-EF (HR 4.41, 95% CI: 1.72-11.36, p = .002) and moderate/severe mitral regurgitation (HR 2.32, 95% CI: 1.02-5.30, p = .046) as independent predictors of adverse cardiac outcome in patients with VT/VF.

Conclusion: PI-LVA patients with VT/VF are at high risk of adverse cardiac outcome, and coronary revascularization does not mitigate this risk, although revascularization was associated with higher cardiac survival in PI-LVA patients without VT/VF.

Keywords: post-infarction left ventricular aneurysm; revascularization; ventricular tachyarrhythmia.

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Conflict of interest statement

None declared.

Figures

FIGURE 1
FIGURE 1
The Kaplan–Meier survival analysis for 4 groups. The survival in group 2 (VT/VF− and revascularization+) was significantly higher than that in other 3 groups
FIGURE 2
FIGURE 2
The Kaplan–Meier survival analysis in PI‐LVA patients according to the presence of VT/VF and treatment strategies. p values were calculated with the log‐rank test. Cumulative cardiac survive are shown for VT/VF− (left panel) and VT/VF+ (right panel) subgroup
See this image and copyright information in PMC

References

    1. Beanlands, R. S. B. , Nichol, G. , Huszti, E. , Humen, D. , Racine, N. , Freeman, M. , Gulenchyn, K. Y. , Garrard, L. , deKemp, R. , Guo, A. , Ruddy, T. D. , Benard, F. , Lamy, A. , & Iwanochko, R. M. (2007). F‐18‐fluorodeoxyglucose positron emission tomography imaging‐assisted management of patients with severe left ventricular dysfunction and suspected coronary disease: A randomized, controlled trial (PARR‐2). Journal of the American College of Cardiology, 50(20), 2002–2012. 10.1016/j.jacc.2007.09.006 - DOI - PubMed
    1. Bonow, R. O. , Maurer, G. , Lee, K. L. , Holly, T. A. , Binkley, P. F. , Desvigne‐Nickens, P. , Drozdz, J. , Farsky, P. S. , Feldman, A. M. , Doenst, T. , Michler, R. E. , Berman, D. S. , Nicolau, J. C. , Pellikka, P. A. , Wrobel, K. , Alotti, N. , Asch, F. M. , Favaloro, L. E. , She, L. , … Panza, J. A. (2011). Myocardial viability and survival in ischemic left ventricular dysfunction. New England Journal of Medicine, 364(17), 1617–1625. 10.1056/NEJMoa1100358 - DOI - PMC - PubMed
    1. Brockes, C. , Rahn‐Schonbeck, M. , Duru, F. , Candinas, R. , Seifert, B. , & Turina, M. (2002). ICD implantation with and without combined myocardial revascularisation–incidence of ICD therapy and late survival. The Thoracic and Cardiovascular Surgeon, 50(6), 333–336. 10.1055/s-2002-35741 - DOI - PubMed
    1. Canty, J. M. Jr , & Fallavollita, J. A. (2005). Hibernating myocardium. Journal of Nuclear Cardiology, 12(1), 104–119. 10.1016/j.nuclcard.2004.11.003 - DOI - PubMed
    1. Canty, J. M. Jr , Suzuki, G. , Banas, M. D. , Verheyen, F. , Borgers, M. , & Fallavollita, J. A. (2004). Hibernating myocardium: Chronically adapted to ischemia but vulnerable to sudden death. Circulation Research, 94(8), 1142–1149. 10.1161/01.RES.0000125628.57672.CF - DOI - PubMed

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