Exercise tolerance in patients with and without ventricular aneurysm

To assess the role of a left ventricular aneurysm (VA) in affecting cardiac pump function, 36 patients with an echo-proved postmyocardial infarction (MI) VA underwent maximal symptom limited exercise testing. A control group was formed of 36 patients with a previous MI without VA. The two groups were matched for age, sex, and site of MI. No difference was found in maximal work capacity (MWC), heart rate (HR), systolic blood pressure (BP), delta HR/k rho m, delta BP and VO2max/kg during exercise. MWC in patients with VA and anterior MI was lower as compared to patients with VA and inferior MI (2,839.3 +/- 1,340.9 vs. 4,537.5 +/- 1,453.7, p less than 0.05) while no difference was found between anterior and inferior MI without VA. Patients with VA and anterior MI tolerated lower workloads as compared to those with anterior MI without VA (2,839.3 +/- 1,340.9 vs. 3,996.4 +/- 2,347.1, p less than 0.05). No difference was found between patients with inferior MI with or without VA. No major adverse cardiovascular events occurred during or after the tests. Patients were grouped for echo-estimated ejection fraction (EF) less than 30%, 30-50% and greater than 50%. Only 1 patient without VA was found among patients with EF less than 30%. In both groups MWC increased with the increase of EF. Patients with VA, anterior MI and EF less than 30% showed the lowest exercise tolerance (2,216.6 +/- 529.1), and no patient with VA and inferior MI exhibited EF less than 30%. In conclusion, in patients with VA, exercise testing is a safe and useful tool to evaluate the functional capacity of the residual 'non-aneurysmatic' myocardium.