The Effect Of F-FDG Myocardial Metabolic Imaging On Left Ventricular Aneurysm Surviving Myocardium And Its Combined Ventricular Arrhythmias In Patients With Long-term Prognosis

Objective:To evaluate the long-term survival of patients with viable myocardium in left ventricular aneurysm(LVA) and ventricular arrhythmias.Methods:One-hundred sixty consecutive patients with LVA (139 men, mean age 58±10 y) who underwent 99Tcm-MIBI SPECT and 18F-FDG PET were followed up for a mean of 50 ± 7 months. Only cardiac death during follow-up served as the endpoint. Viable myocardium in aneurysm was defined as perfusion-metabolism mismatch score (MMS)≥2.0. Patients were divided into 4 groups according to aneurysmal viability and ventricular arrhythmias. Group 1(n=68,42.5%):viability-, ventricular arrhythmias-; Group 2(n=29,18.1%):viability-,ventricular arrhythmias+; Group 3(n=50,31.3%): viability+, ventricular arrhythmias-; Group 4 (n=13,8.1%):viability+, ventricular arrhythmias+.Results:There were 19 patients (11.9%) suffered from cardiac death. The survivals in groups 1,2 and 3 had no statistically significance difference (94.1%,89.7%,86.0%, respectively, P>0.05), while survival in group 4 (61.5%)was the lowest (P=0.004). Multivariate Cox regression analysis showed that female [hazard ratio(HR) 5.101,95% confidence interval(CI):1.853～14.044, P=0.002], GPET-ESV (HR 1.009,95% CI: 1.002～1.015, P=0.013), interaction between MMS and ventricular arrhythmias (HR 1.368,95%CI:1.113～1.681, P=0.003) were positive independent predictors of cardiac death, and surgical treatment (HR 0.199,95% CI:0.054～0.742, P=0.016) was a negative independent predictor for cardiac death.Conclusion:Patients with viable aneurysm and ventricular arrhythmias were at high risk for cardiac death and should be treated by early surgery and antiarrhythmic therapy.Objective:To evaluate the prevalence of viable myocardium and ventricular arrhythmias (VA) in patients with left ventricular aneurysm and their impacts on the long-term survival, and compare the different impacts between medical and surgical treatment.Methods:One-hundred and ninety-four consecutive left ventricular aneurysm patients (diagnosed by MRI and/or echo) (170 male, mean ages of 57 ± 10 years, mean EF by gated PET 34 ± 12%) who underwent 99Tcm-MIBI SPECT and 18F-FDG PET were retrospectively evaluated. VA was recorded in 53 (27.3%) patients. Patients were divided into four groups according to aneurysmal viability (mismatch score≥ 2.0) and VA. Group 1 (n= 86,44.3%):viability-, VA-; Group 2 (n= 36,18.6%):viability-, VA+; Group 3 (n= 55,28.3%):viability+, VA-; Group 4 (n= 17,8.8%):viability+, VA+.Results:After a mean follow-up of 46 ± 16 months,26 (13.4%) patients suffered from cardiac death. Prevalence of VA did not differ between patients with and without viable aneurysm (23.6% vs.29.5%,/= 0.79, P= 0.374). Cardiac mortality rate had a trend to be significantly higher in patients with viable aneurysm than that in patients without viable aneurysm (22.2% vs 8.2%, χ2=8.439, P=0.004). Among four groups, annual cardiac mortality rate was the highest in group 4 (9.2%) and the lowest in group 1 (1.8%)(P=0.003). No significant difference was observed between medical therapy and revascularization in group 1 (2.1% vs.1.6%,χ2= 0.20, P= 0.657). Additionally, in comparison with medical therapy, annual cardiac mortality rate of patients in groups 2 (0% vs.5.0%,χ2= 3.09, P= 0.079) and group 4 (5.2% vs.14.9%,χ2= 2.34, P= 0.126) has a trend to be reduced by revascularization, and it was significantly decreased by revascularization (0.8% vs.11.2%,χ2= 15.04, P< 0.001) in group 3. Multivariate Cox regression analysis showed that interaction between aneurysmal viability and GPET-ESV (HR 1.010,95% CI:1.005-1.015, P< 0.001) was a positive independent predictor for cardiac mortality, revascularization (HR 0.235,95% CI:0.094-0.589, P= 0.002) was a negative independent predictor for cardiac mortality.Conclusion:Among left ventricular aneurysm patients, the prevalence of patients without viable aneurysm and without VA was the highest, and their long-term cardiac survival was promising (5-year survival rate> 90%), no matter treated by medical therapy or revascularization. In addition, the prevalence of patients with viable aneurysm and with VA was the lowest, while those patients were at the highest risk for cardiac death, which should be treated by revascularization together with anti-arrhythmic therapy. Finally, patients with viable aneurysm and without VA were at high risk for cardiac death, while revascularization significantly improved cardiac survival.