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Endocardial abnormalities in left ventricular aneurysms. A clinicopathologic study.

J S Hochman, E B Platia, B H Bulkley

    Annals of Internal Medicine
    |January 1, 1984
    PubMed
    Summary
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    Left ventricular aneurysms with thick endocardial plaques (Type I) are linked to ventricular tachycardia. Aneurysms lacking this plaque (Type II) were associated with systemic emboli, suggesting structural differences impact clinical outcomes.

    Area of Science:

    • Cardiology
    • Pathology

    Background:

    • Left ventricular aneurysms are a known complication following myocardial infarction.
    • Clinical manifestations include ventricular arrhythmias, congestive heart failure, and systemic emboli.

    Purpose of the Study:

    • To correlate specific morphologic subgroups of left ventricular aneurysms with distinct clinical manifestations.
    • To investigate the pathophysiologic significance of structural differences in ventricular aneurysms.

    Main Methods:

    • Studied 73 patients with left ventricular aneurysms (34 autopsy, 45 surgical excision).
    • Classified aneurysms into two types based on endocardial abnormalities: Type I (thick endocardial plaque) and Type II (minimal endocardial fibroelastosis).
    • Correlated aneurysm type with clinical history of congestive heart failure, systemic emboli, and recurrent ventricular tachycardia.

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    Main Results:

    • Sixty-three patients had congestive heart failure, 5 had systemic emboli, and 28 had recurrent ventricular tachycardia.
    • Type I aneurysms (n=30) were associated with recurrent ventricular tachycardia in 20 patients.
    • Type II aneurysms (n=43) were associated with systemic emboli in 5 patients with mural thrombi.
    • Ventricular tachycardia occurred significantly more often in Type I versus Type II aneurysms (p < 0.001).

    Conclusions:

    • Structural differences in left ventricular aneurysms, specifically endocardial fibroelastosis, are pathologically significant.
    • Findings suggest a link between endocardial fibroelastosis and the mechanism of ventricular tachycardia in postinfarction patients.
    • These insights may inform prevention strategies for ventricular tachycardia, potentially through endocardial resection.