Left ventricular aneurism and long-term survival of patients with heart failure with a past history of myocardial infarction

Introduction: Left ventricular aneurysm (LVA) is a complication of myocardial infarction occurring in 8-15% of patients, with unclear long-term prognostic significance.
Aim: Our objective is to assess the impact of a LVA on long-term all-cause mortality of patients with heart fa-ilure due to ischemic coronary disease.
Methods: Patients with heart failure with prior myo-cardial infarction admitted to our clinic from January 2011 to December 2014 were retrospectively enrolled in this study. Acute coronary syndromes, neoplasms, pulmonary embolisms and systemic infections were exclusion criteria. Survival status was assessed in June 2018. Mean follow-up was 5.5 years.
Results: Our sample consisted of 203 patients, 62.6% male with a mean age of 70.72±10.6 years. 55 had LVA. All-cause long-term mortality was 47% with no signi-ficant difference between patients with (48.15%) and without LVA (45.77%), p=0.89.
LVA did not increase the long-term all-cause morta-lity risk (RR 1.05, 95%CI 0.75-1.46, p=0.89).
In ROC curve analysis, age (AUC 0.627 (95%CI 0.549-0.705), p=0.002), NT-proBNP (AUC 0.723 (95%CI 0.648-0.798), p<0.01) and left ventricular ejec-tion fraction (LVEF) (AUC 0.646 (95%CI 0.565-0.727), p=0.001) were predictors of long-term all-cause morta-lity in all patients.
Patients with LVA were younger (66.87±11.42 ver-sus 72.06±9.99 years, p=0.001), but had higher median (interquartile range) NT-proBNP levels (3320 (1341; 9346) versus 1386 (557; 4158) pg/ml, p=0.004) and lower median LVEF (27% (20; 35) versus 45% (35; 50), p<0.001).
In ROC curve analysis, in patients with LVA the predictors for all-cause mortality were age (AUC 0.675 (95%CI 0.527-0.823), p=0.026) and NT-proBNP (AUC 0.703 (95%CI 0.531-0.875), p=0.035).
Conclusions: Patients with heart failure and prior MI complicated with a left ventricular aneurysm had hi-gher NT-proBNP levels and lower ejection fraction. However, this complication was not associated with hi-gher long-term all-cause mortality.
Age, NT-proBNP levels and LVEF were independent predictors of survival in these patients.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)