title: The Influence of Apical Aneurysm on Left Ventricular Geometry and Clinical Outcomes: 3-Year Follow-Up Using Echocardiography.
abstract: BACKGROUND
  Left ventricular apical aneurysm (LVAA) is a serious complication associated with myocardial infarction. However, the effects of a previously formed LVAA on long-term left ventricular (LV) geometry and clinical outcomes have not been fully evaluated.
  
  
  METHODS
  From January 2009 to May 2015, we retrospectively identified 70 patients (mean age, 66 ± 12 years; males, 72.9%) with an LVAA due to ischemia. These patients were classified into two groups according to the initial apical conicity ratio (ACR): large LVAA group (ACR ≥ 1.5, n = 40) and small LVAA group (ACR < 1.5, n = 30). An adverse outcome was defined as a composite of fatal arrhythmia, embolic infarction, and readmission due to heart failure.
  
  
  RESULTS
  The ACR significantly decreased over the first month and then increased after 1 and 3 years of follow-up. The other examined echocardiographic indexes did not exhibit temporal changes. During the follow-up period (median 1138 days), the large LVAA group experienced a lower event-free survival (P = 0.016). In a multivariate Cox model, the presence of a large LVAA (adjusted hazard ratio [HR] = 2.795, 95% confidence interval [CI] = 1.118-6.986, P = 0.028) and the initial LV ejection fraction (EF) (adjusted HR = 0.964, 95% CI = 0.932-0.997, P = 0.034) were independent predictors of adverse outcomes.
  
  
  CONCLUSIONS
  This study demonstrates that LVAAs undergo a dynamic process and that large LVAAs are associated with adverse outcomes. Our results suggest that the ACR could be helpful for predicting adverse outcomes in patients with apical aneurysm.
authors.affiliation: Cardiovascular Center, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Mi-Hyang
authors.identifier: http://orcid.org/0000-0003-0224-5178
authors.initials: MH
authors.lastname: Jung
authors.affiliation: Cardiovascular Center, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Ho-Joong
authors.initials: HJ
authors.lastname: Youn
authors.affiliation: Cardiovascular Center, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Hae Ok
authors.initials: HO
authors.lastname: Jung
mesh_terms: D000368:Aged; D015897:Comorbidity; D004452:Echocardiography / Q000706:statistics & numerical data; D004617:Embolism / Q000000981:diagnostic imaging / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006322:Heart Aneurysm / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009929:Organ Size; D010359:Patient Readmission / Q000706:statistics & numerical data*; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left
keywords: heart aneurysm; myocardial ischemia; ventricular remodeling