[Evaluation of left ventricular aneurysms before and after surgery using Cine-MRI].
OBJECTIVE
To demonstrate the usefulness of cine-MRI for the evaluation of apical left ventricular aneurysms (ALVA) and for prediction of the surgical outcome.


METHODS
We investigated 28 patients with ALVA, 13 of them additionally after aneurysmectomy at 1.5 T; 15 healthy volunteers served as normal controls. For cine-MRI k-space segmented Fl-2D-GE sequences were used. Analysis comprised the calculation of cardiac volume indices, cardiac function, and percentual myocardial thickening (PMT). For prediction of surgical results we divided left ventricle into an aneurysmatic and a non-aneurysmatic part. The non-aneurysmatic part was assumed as the left ventricle after surgical remodelling.


RESULTS
Enddiastolic and endsystolic volume indices (EDVIs and LV-ESVIs) were higher in patients with ALVA (123.7 +/- 30.2 ml/m(2), 94.3 +/- 32.5 ml/m(2), respectively) than in volunteers (79.1 +/- 13.9 ml/m(2), 25.5 +/- 5.1 ml/m(2), respectively) (p < 0.001). Stroke volume index (SVIs), cardiac index (CIs) and ejection fraction (EFs) were significantly lower in patients (30.4 +/- 9.1 vs. 54.2 +/- 0.2 ml/beat/m(2); 2.2 +/- 0.8 vs. 3.9 +/- 0.9 l/min/m(2), 26.0 +/- 9.7 vs. 67.9 +/- 4.5 %, respectively) (p < 0.001). There was a significant decrease of LV-EDVIs and LV-ESVIs (102.8 +/- 30.3 ml/m(2), 66.3 +/- 28.0 ml/m(2), respectively) (p = 0,002, p < 0.001, respectively), no change of SVIs (36.4 +/- 6.0 ml/beat/m(2)) (p > 0.05) and a significant increase of CIs and EFs (3.0 +/- 0.6 l/min/m(2), 37.91 +/- 10.15 %, respectively) (p < 0.001) after surgery. We found a good correlation between the preoperatively calculated (32.6 +/- 10.1 %) and the measured EF after surgery (37.9 +/- 9.8 %) (r = 0.70; p = 0.035). PMT was significantly lower in patients than in volunteers (median 11.9 +/- 10.7 vs. 70.2 +/- 13.9 %; p < 0.001), especially in the aneurysmatic parts of left ventricle (median - 6.8 %; p < 0.001).


CONCLUSIONS
Cine-MRI offers accurate evaluation of ALVA and enables preoperative estimation of left-ventricular volumes after surgery.
Mohrs
O K
OK
Klinik und Poliklinik für Radiologie, Johannes-Gutenberg-Universität Mainz. mohrs@radiologie.klinik-uni-mainz.de
Bachmann
G F
GF
Oesingmann
N
N
Kalden
P
P
Rominger
M B
MB
Kreitner
K F
KF
Thelen
M
M
D000368:Aged; D000369:Aged, 80 and over; D002306:Cardiac Volume / Q000502:physiology; D005260:Female; D006322:Heart Aneurysm / Q000175:diagnosis* / Q000601:surgery; D006352:Heart Ventricles / Q000473:pathology / Q000601:surgery; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis*; D012189:Retrospective Studies; D014584:User-Computer Interface; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000601:surgery