Js. Hochman et al., PROGNOSTIC-SIGNIFICANCE OF LEFT-VENTRICULAR ANEURYSM IN THE CARDIAC-ARRHYTHMIA-SUPPRESSION-TRIAL (CAST) POPULATION, The American heart journal, 127(4), 1994, pp. 824-832
Left ventricular aneurysm has been associated with increased mortality
rates. The Cardiac Arrhythmia Suppression Trial (CAST) database was u
sed prospectively to assess (1) the prognostic significance of left ve
ntricular (LV) aneurysm after myocardial infarction on mortality rates
and (2) the relation of LV aneurysm to ventricular arrhythmias and th
eir suppressibility. All patients in the CAST study were enrolled afte
r myocardial infarction. They had greater than or equal to 6 ventricul
ar premature depolarizations (VPDs) per hour and ejection fraction les
s than or equal to 55%; they were enrolled in the study an average of
96 days after the index myocardial infarction. Of 2494 patients with w
all motion data, 164 had LV aneurysm, 600 had only dyskinesis, 913 had
only akinesis, and 817 had none of these. Radionuclide scan was used
in 39%, two-dimensional echocardiography in 30%, and LV angiogram in 3
1%. Baseline VPDs and nonsustained ventricular tachycardia were simila
r in all groups. LV aneurysm patients were more frequently eliminated
during open-label titration. The incidence of sustained VT during foll
ow-up was only 2.8% for aneurysm patients, a rate that was similar to
the other groups. Patients with LV aneurysm had significantly lower su
rvival rates (82% vs 91%) at 16 months after study entry than those wi
thout these wall motion abnormalities (p < 0.005). When survival rates
were adjusted for ejection fraction there was still a moderately larg
e hazard ratio (1.34) of LV aneurysm that was not statistically signif
icant (p = 0.18). We conclude that (1) the presence of LV aneurysm doe
s not independently worsen prognosis, and (2) older concepts of LV ane
urysm and ventricular arrhythmias must be reevaluated.