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Song Y, Xu F, Feng W. Surgical treatment of left ventricular aneurysm in patients with prior myocardial infarction in the absence of obstructive coronary artery disease (MINOCA): a cohort study. J Cardiothorac Surg 2023; 18:304. [PMID: 37907998 PMCID: PMC10617135 DOI: 10.1186/s13019-023-02385-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 09/30/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND There is a paucity of studies examining the treatment of patients with prior myocardial infarction in the absence of obstructive coronary arteries (MINOCA) and with a concomitant left ventricular aneurysm. Our study aims to illustrate the clinical characteristics and report the mid-term surgical outcomes in this distinct entity. METHODS Ten patients with MINOCA and left ventricular aneurysm were investigated. The MINOCA was diagnosed according to Scientific Statement from the American Heart Association. The indication for left ventricular reconstruction was as follows: clear evidence of both an aneurysmal and akinetic left ventricle with a history of myocardial infarction accompanied by heart failure symptoms, angina, or ventricular arrhythmias. Major adverse cardiovascular and cerebrovascular events (MACCE), including death, myocardial infarction, stroke was considered the primary endpoints. RESULTS The median follow-up for the whole study population was 64.5 months. Seven MINOCA patients developed a left ventricular aneurysm within 4 years and three MINOCA patients were found to have a concomitant left aneurysm at the first admission. Before surgery, no patients were prescribed angiotensin-converting enzyme inhibitors. Statins, dual antiplatelet therapy, and β-blockers were prescribed in 2, 5, and 5 patients, respectively. After surgery, no MACCE occurred in the follow-up. There was a significant increase in ejection fraction (EF) in the follow-up (p = 0.0009). CONCLUSIONS Close monitoring and standard medical treatment are required before a left ventricular aneurysm occurs in MINOCA patients. Left ventricular reconstruction remains a viable option for MINOCA patients with left ventricular aneurysms and mid-term outcomes were satisfying in this distinct entity.
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Affiliation(s)
- Yangwu Song
- Department of Cardiovascular Surgery, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Xu
- Department of Cardiovascular Surgery, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Feng
- Department of Cardiovascular Surgery, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Tiemuerniyazi X, Chen L, Song Y, Zhao W, Feng W. Clinical Outcomes After the Surgical Treatment of Hypertrophic Obstructive Cardiomyopathy With Left Ventricular Apical Aneurysm. Heart Lung Circ 2023; 32:1122-1127. [PMID: 37355430 DOI: 10.1016/j.hlc.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 04/12/2023] [Accepted: 05/06/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Left ventricular apical aneurysm (LVAA) is a rare complication of hypertrophic obstructive cardiomyopathy (HOCM). This study aimed to illustrate the clinical characteristics and surgical outcomes of these patients. METHOD Patients with HOCM and LVAA who underwent modified extended Morrow myectomy and surgical left ventricular reconstruction (SLVR) between October 2012 and March 2021 were retrospectively recruited. Patients with coronary artery disease were excluded. Clinical characteristics were summarised. Time-to-event outcomes were calculated using the Kaplan-Meier method and compared by a log-rank test. RESULTS Fifteen eligible patients were identified; the mean age was 39.9±17.2 years and 40.0% of them were female. All patients had dyspnoea, 46.7% presented with syncope and/or chest pain, and 13.3% had a family history of hypertrophic cardiomyopathy. The mean LVAA size was 36.9±12.3 mm in length and 28.5±11.3 mm in width. Echocardiography showed LV outflow tract obstruction in seven (46.7%) patients, mid-cavity LV obstruction in 12 (80.0%), while systolic anterior motion (SAM) was seen in seven (46.7%). The symptoms were resolved in all patients postoperatively. During a median follow-up of 22.0 months, one (6.7%) patient had sudden cardiac death, one (6.7%) had a haemorrhagic stroke, and the LVAA recurrence was 40.0%. Subgroup analysis showed that signs of SAM and larger LVAA (≥30 mm) were associated with an increased tendency for a longer hospital stay. CONCLUSIONS Patients with HOCM and LVAA present with high-risk profiles. Modified extended Morrow myectomy combined with SLVR is useful in relieving the symptoms and improving the prognosis, although there might be recurrent LVAA.
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Affiliation(s)
- Xieraili Tiemuerniyazi
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liangcai Chen
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yangwu Song
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Zhao
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Feng
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Nan Y, Tiemuerniyazi X, Chen L, Song Y, Feng W, Xu F. Prognostic value of carbohydrate antigen 125 in patients undergoing surgical left ventricular reconstruction. Int J Cardiol 2023; 371:377-383. [PMID: 36208679 DOI: 10.1016/j.ijcard.2022.09.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 08/26/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Carbohydrate antigen 125 (CA125) is a biomarker often used in diagnosis of ovarian tumors. Studies also show that elevated CA125 implicates worse outcomes among patients with heart failure, while latter of which plays an important role in the pathophysiology of left ventricular aneurysm (LVA). However, the prognostic value of CA125 in LVA patients undergoing surgical left ventricular reconstruction (SLVR) remains unclear. METHODS In this single-centered cohort study, a total of 309 patients with LVA undergoing SLVR were retrospectively recruited. Univariable regression analysis was performed to identify the potential confounders for each outcome, followed by multivariable adjustment to confirm the association between CA125 and outcomes. The primary outcome was the overall mortality, and the secondary outcome was the major adverse cardiovascular and cerebrovascular events (MACCE) and perioperative outcomes. A receiver operating characteristic (ROC) curve was use to find the optimal cut-off value of CA125. RESULTS The median follow-up time was 55 months. The cohort was predominantly male (86.4%), with an average age of 58.6 years. Log (CA125) was associated with overall mortality (hazard ratio [HR]: 2.15, 95% confidence interval [CI]: 1.06-4.36, P = 0.033), prolonged hospital-stay time (HR:1.07, 95%CI: 1.03-1.12, P = 0.001) and increased risk of postoperative ventricular support (HR: 2.81, 95%CI: 1.10-7.18, P = 0.031) after multivariate adjustment. The optimal cut-off value for the CA125 for all-cause mortality was 13.825 U/ml with the area under curve of 0.675. CONCLUSION Elevated-CA125 implicates poorer short- and long-term prognosis in LVA patients undergoing SLVR.
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Affiliation(s)
- Yifeng Nan
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xieraili Tiemuerniyazi
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liangcai Chen
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yangwu Song
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Feng
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Fei Xu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Zhang S, Huang S, Tiemuerniyazi X, Song Y, Feng W. Is 3-6 months anticoagulation with warfarin necessary after left ventricular thrombectomy with left ventricular aneurysm surgery? J Card Surg 2022; 37:5103-5110. [PMID: 36378885 PMCID: PMC10099739 DOI: 10.1111/jocs.17215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/27/2022] [Accepted: 10/29/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES No recommendation exists on the optimal antithrombotic therapy after left ventricular thrombus (LVT) resection in the current guidelines. The study aimed to investigate the role of prophylactic anticoagulation with warfarin for 3-6 months in LVT recurrence and other clinical outcomes after LVT resection and left ventricular aneurysm (LVA) surgery. METHODS All consecutive patients undergoing LVT resection together with LVA surgery in our institution between 2010.1.1 and 2021.4.1 were included in the study. Individuals included were divided into two groups based on whether warfarin was administered at discharge. Patients with warfarin were matched to their counterparts without warfarin based on the baseline characteristics via propensity score matching (PSM) at the ratio of 1:1. The primary outcome was LVT recurrence. The secondary outcomes were major adverse cardiac and cerebrovascular events (MACCEs) and the composite endpoint of LVT recurrence and MACCEs. RESULTS After PSM, a total of 118 patients were included in the study, among whom 59 received warfarin therapy at discharge and 59 didn't. During the median follow-up of 56.5 months, 21 out of 118 patients had LVT recurrence and the recurrence rate was 17.8% There was no systemic embolism resulting from the recurrent LVT. Kaplan-Meir analysis showed no significant difference in LVT recurrence (p = .86), MACCEs (p = .48) and the composite endpoint of LVT recurrence, and MACCEs (p = .89). Cox proportional hazards regression model showed that history of PCI (hazard ratio [HR] 2.778, 95% confidence interval [CI] 1.087-7.100, p = .033) and LVA surgical strategy of linear suture (HR 8.768, 95% CI 1.139-67.517, p = .037) were independent risk factors of LVT recurrence. CONCLUSIONS Prophylactic anticoagulation with warfarin for 3-6 months may be unnecessary with no benefit in terms of LVT recurrence and other clinical outcomes.
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Affiliation(s)
- Shicheng Zhang
- Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovacular Diseases, Beijing, China
| | - Siyuan Huang
- Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovacular Diseases, Beijing, China
| | - Xieraili Tiemuerniyazi
- Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovacular Diseases, Beijing, China
| | - Yangwu Song
- Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovacular Diseases, Beijing, China
| | - Wei Feng
- Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovacular Diseases, Beijing, China
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Ma H, Zhang S, Chen L, Nan Y, Tiemuerniyazi X, Huang S, Zhao D, Feng W. Results of different therapeutic strategies for left ventricular aneurysm with mitral regurgitation. Coron Artery Dis 2022; 33:440-445. [PMID: 35383590 DOI: 10.1097/mca.0000000000001146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aims to compare the midterm outcomes of left ventricular reconstruction (LVR) added to coronary artery bypass grafting (CABG) with those of CABG alone in patients with left ventricular aneurysm (LVA) and mild or moderate mitral regurgitation (MR). We also assessed the impact of LVR on the degree of MR. METHODS A total of 130 patients (77 who underwent CABG plus LVR and 53 who underwent CABG alone) with concomitant mild or moderate MR were included in the study population. All-cause mortality was considered the primary endpoint. Major adverse cardiovascular and cerebrovascular events (MACCEs), including death, myocardial infarction, stroke, and subsequent mitral valve surgery, were considered secondary endpoints. Kaplan-Meier analysis was performed to evaluate event-free survival. MR was graded 0 to 4+ by echocardiogram. RESULTS The median follow-up time among all patients was 22 months. There was a significant difference between the CABG plus LVR and CABG alone groups with regard to all-cause mortality ( P = 0.019). However, the statistical difference was not observed in cardiogenic mortality ( P = 0.186) and MACCEs ( P = 0.107). In the grade of MR, the two groups both resulted in the decreased grade of MR, but the CABG plus LVR group had a significant number of patients improving to 0 or 1+ ( P = 0.030). CONCLUSION The clinical outcomes of CABG alone are comparable with those of CABG plus LVR in patients with LVA and mild or moderate MR. However, CABG+LVR demonstrated greater reduction in MR severity after surgery than CABG alone.
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Affiliation(s)
- Hao Ma
- Department of Cardiac Surgery, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Results of Left Ventricular Reconstruction With and Without Mitral Valve Surgery. Ann Thorac Surg 2019; 109:753-761. [PMID: 31472132 DOI: 10.1016/j.athoracsur.2019.07.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/22/2019] [Accepted: 07/05/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND This study aims to compare the midterm outcomes of left ventricular reconstruction with those of left ventricular reconstruction plus mitral valve surgery in patients with left ventricular aneurysm due to anterior myocardial infarction and moderate mitral regurgitation. METHODS A total of 523 patients (75 who underwent left ventricular reconstruction plus mitral valve surgery and 448 who underwent left ventricular reconstruction) with concomitant moderate mitral regurgitation were included in the study population. All-cause mortality was considered the primary endpoint. Major adverse cardiovascular and cerebrovascular events, including death, myocardial infarction, stroke, and subsequent mitral valve surgery, were considered secondary endpoints. Multivariable proportional hazards Cox regression models were used to assess the associations between groups and outcomes. In the sensitivity analysis we excluded patients who did not undergo coronary artery bypass graft and repeated the statistical analysis above. RESULTS The median follow-up time among all patients was 41 months. There was no significant difference between the left ventricular reconstruction plus mitral valve surgery and the left ventricular reconstruction groups with regard to all-cause mortality (P = .208) and major adverse cardiovascular and cerebrovascular events (P = .817) after adjustment for covariates. In the sensitivity analysis there was no significant difference between the left ventricular reconstruction plus mitral valve surgery and left ventricular reconstruction groups with regard to all-cause mortality (P = .158) and major adverse cardiovascular and cerebrovascular events (P = .651) after adjustment for covariates. CONCLUSIONS The clinical outcomes of left ventricular reconstruction are comparable with those of left ventricular reconstruction plus mitral valve surgery in patients with left aneurysm and moderate mitral regurgitation.
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Kaya U, Çolak A, Becit N, Ceviz M, Kocak H. Application of Circular Patch Plasty (Dor Procedure) or Linear Repair Techniques in the Treatment of Left Ventricular Aneurysms. Braz J Cardiovasc Surg 2018; 33:135-142. [PMID: 29898142 PMCID: PMC5985839 DOI: 10.21470/1678-9741-2017-0093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 09/12/2017] [Indexed: 11/06/2022] Open
Abstract
Objective The aim of this study was to evaluate early clinical outcomes and
echocardiographic measurements of the left ventricle in patients who
underwent left ventricular aneurysm repair using two different techniques
associated to myocardial revascularization. Methods Eighty-nine patients (74 males, 15 females; mean age 58±8.4 years;
range: 41 to 80 years) underwent post-infarction left ventricular aneurysm
repair and myocardial revascularization performed between 1996 and 2016.
Ventricular reconstruction was performed using endoventricular circular
patch plasty (Dor procedure) (n=48; group A) or linear repair technique
(n=41; group B). Results Multi-vessel disease in 55 (61.7%) and isolated left anterior descending
(LAD) disease in 34 (38.2%) patients were identified. Five (5.6%) patients
underwent aneurysmectomy alone, while the remaining 84 (94.3%) patients had
aneurysmectomy with bypass. The mean number of grafts per patient was
2.1±1.2 with the Dor procedure and 2.9±1.3 with the linear
repair technique. In-hospital mortality occurred in 4.1% and 7.3% in group A
and group B, respectively (P>0.05). Conclusion The results of our study demonstrate that post-infarction left ventricular
aneurysm repair can be performed with both techniques with acceptable
surgical risk and with satisfactory hemodynamic improvement.
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Hong Z, Yuming M, Chunmei W, Xue Y. The value of myocardial torsion and aneurysm volume for evaluating cardiac function in rabbit with left ventricular aneurysm. PLoS One 2015; 10:e0121876. [PMID: 25855970 PMCID: PMC4391835 DOI: 10.1371/journal.pone.0121876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 02/18/2015] [Indexed: 11/30/2022] Open
Abstract
Objective This study aimed to investigate the effect of left ventricular aneurysm (LVA) volume and left ventricular global torsion on cardiac function by real time three-dimensional echocardiography (RT-3DE) and two-dimensional speckle tracking imaging(2D-STI), to determine the accuracy of RT-3DE and 2D-STI in assessing LV function. Methods Thirty New Zealand rabbit models of with LVA were prepared by ligation of the middle segment of the left anterior descending and left circumflex arteries. Four weeks post-procedure, RT-3DE was conducted to obtain data on LVEF, left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), and LVA volume (LVAV), Peak rotation angles at the mitral valve annulus level (MV-ROT), peak rotation angles at the apical level (AP-ROT), and left ventricular global torsion angles (LV-TOR) were measured by 2D-STI. Results Compared with controls, LVEDV and LVESV were significantly increased in the LVA group, while LVEF, MV-ROT, AP-ROT, and LV-TOR were consistently reduced (p<0.01). Moreover, LVEF correlated with LVA volume and LV torsion angle (r= -0.778 and 0.821, p<0.01). LVA volume/LVEDV had the strongest inverse relationship with LVEF (r= -0.911, p<0.01). Conclusion LVA volume, LVA volume/LVEDV, and LV torsion may be used as an indicator for evaluation of cardiac function after LVA. Moreover, LVA volume/LVEDV may be a more sensitive and reliable marker of cardiac function after LVA formation.
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Affiliation(s)
- Zhai Hong
- Department of Ultrasonography, Affiliated Traditional Chinese Medicine Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Mu Yuming
- Department of Echocardiography, First Affiliated Hospital, Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
- * E-mail:
| | - Wang Chunmei
- Department of Echocardiography, First Affiliated Hospital, Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Yan Xue
- Department of Echocardiography, First Affiliated Hospital, Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
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Zhai H, Mu Y, Guan L, Li Y. The Value of Aneurysm Volume and Myocardial Strain Rate for Evaluating Cardiac Function of Ischemia-Related Left Ventricular Aneurysm in a Rabbit Model Using Real Time Three-Dimensional Echocardiographic Imaging Combined with Speckle Tracking Imaging. Echocardiography 2013; 30:837-42. [PMID: 23432407 DOI: 10.1111/echo.12144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Hong Zhai
- Department of Echocardiography; First Affiliated Hospital; Xinjiang Medical University; Urumqi; China
| | - Yuming Mu
- Department of Echocardiography; First Affiliated Hospital; Xinjiang Medical University; Urumqi; China
| | - Lina Guan
- Department of Echocardiography; First Affiliated Hospital; Xinjiang Medical University; Urumqi; China
| | - Yanhong Li
- Department of Echocardiography; First Affiliated Hospital; Xinjiang Medical University; Urumqi; China
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Fan H, Zheng Z, Feng W, Zhang Y, Jin L, Li P, Hu S. Apical conicity ratio: A new index on left ventricular apical geometry after myocardial infarction. J Thorac Cardiovasc Surg 2010; 140:1402-7.e1-3. [DOI: 10.1016/j.jtcvs.2010.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 01/10/2010] [Accepted: 02/08/2010] [Indexed: 10/19/2022]
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