Differentiating Apical and Basal Left Ventricular Aneurysms Using Sphericity Index: A Clinical Study

Area of Science:

• Cardiology
• Echocardiography
• Cardiac Surgery

Background:

• Left ventricular aneurysm (LVA) alters cardiac geometry, reducing systolic function and increasing sphericity.
• The sphericity index (SI), a ratio of short to long axis, quantifies this geometric change.
• Differentiating between apical (A-LVA) and basal (B-LVA) aneurysms is crucial for understanding clinical implications.

Purpose of the Study:

• To evaluate the diagnostic value of SI in distinguishing A-LVA from B-LVA.
• To identify factors influencing SI in patients with LVA.
• To assess the clinical relevance of SI in predicting surgical outcomes.

Main Methods:

• A clinical study involving 54 patients with post-infarction LVA.
• Echocardiography was used to determine LVA location (apical vs. basal) and measure SI and other cardiac parameters.
• Data were analyzed for the entire cohort and stratified by A-LVA and B-LVA groups, considering systolic and diastolic phases.

Main Results:

• Patients with A-LVA (n=41) had lower mean SI (0.51 diastolic, 0.44 systolic) compared to B-LVA (n=13) (0.65 diastolic, 0.57 systolic).
• B-LVA exhibited higher SI due to a reduced long-axis dimension, despite similar left ventricular volumes and ejection fraction (EF) between groups.
• Severe mitral regurgitation significantly increased SI, primarily by reducing the long axis.

Conclusions:

• SI is a valuable echocardiographic marker for differentiating A-LVA and B-LVA.
• B-LVA is characterized by a reduced long axis, leading to higher SI, a condition exacerbated by severe mitral regurgitation.
• Preserving the long axis is critical for surgical ventricular reconstruction (SVR) to achieve a more physiological left ventricular shape and improve outcomes.