Right Ventricular Aneurysm: A New Prognostic Indicator after a First Acute Myocardial Infarction

Abstract

The prognostic implication of a right ventricular aneurysm after a first acute myocardial infarction (AMI) was assessed on a series of 137 AMI patients 12 of whom had a right ventricular aneurysm detected at radionuclide angiocardiography. The follow-up lasted 36 months. Mortality was 50 and 18.4% in patients with and without right ventricular aneurysm, respectively (p < 0.02). Groups did not differ in age, male-to-female ratio, AMI site, left ventricular ejection fraction (LVEF), peak filling rate (PFR), left ventricular size. A multivariate logistic analysis showed that only three out of ten clinical and functional variables qualified to be independent predictors of death: right ventriuclar aneurysm (odd ratio = 2.48, confidence limits = 1.21–4.98), LVEF < 52% (odd ratio = 1.91, confidence limits = 1.03–3.48), abnormal terminal P wave forces (odd ratio = 1.72, confidence limits = 1.07–2.75). The analysis of single case histories did not provide a clue to clarify the reasons accounting for the negative prognostic implication of a right ventricular aneurysm. In conclusion, a significant positive relationship between right ventricular aneurysm and mortality after AMI has been demonstrated; further study is needed to clarify the relevant mechanisms.

Two-Dimensional Transthoracic Echocardiography-Based Diagnosis of Right Ventricular Aneurysm: A Neglected Issue in Patients with Coronary Artery Disease: Case Series and Literature Review

“…Identification of 18 cases of RV aneurysms using 2D TTE among 625 patients with a positive history of IHD in the present study suggests that RV aneurysms are not very uncommon in this group of patients, although the present study was not an epidemiological study and cannot be used to make a conclusion on the frequency or rate of the disease. A series published in 1991 reported diagnoses of 12 cases of RV aneurysm among 137 patients with acute MI (8.75%) who were diagnosed using radionuclide angiocardiography [ 22 ]. This frequency is even higher than that reported in the present series, possibly due to the fact that they did not consider patients with acute MI, while we considered patients with a diagnosis of chronic IHD, among whom only three had a recent acute MI.…”

“…The first case of isolated post-infarct RV aneurysm was reported in 1987 as a postmortem finding [ 15 ]. Besides the case series mentioned above (1991) [ 22 ], another case was reported in 2001 in a patient with acute inferior-posterior MI [ 14 ]. A third case reported in 2004 was of a 66-year-old man who was referred with post-MI angina (inferior MI 21 and 15 years and anteroseptal MI 2 years before) who underwent CABG for the three-vessel disease and was diagnosed with RV aneurysm using TTE and CMR 15 days after surgery [ 12 ].…”