Anatomical vs "Functional" left ventricular aneurysm: angiographic differentiation and management implication

Area of Science:

• Cardiology
• Diagnostic Imaging

Background:

• Accurate diagnosis of left ventricular aneurysm (LVA) is critical for effective surgical treatment.
• Differentiating between true anatomical and functional LVA is essential for patient management.

Purpose of the Study:

• To evaluate the diagnostic efficacy of angiography, including conventional and dynamic ventriculography and coronary angiography, for determining LVA nature.
• To assess the accuracy of these imaging modalities in classifying LVA types.

Main Methods:

• Retrospective analysis of 41 consecutive patients with surgically or autopsied proven LVA.
• Utilized conventional ventriculography, dynamic ventriculography, and coronary angiography for LVA assessment.
• Correlated angiographic findings with surgical and autopsy results.

Main Results:

• Angiography correctly diagnosed all 22 cases of true anatomical LVA.
• For 19 patients with functional LVA, diagnostic accuracy for underlying pathology was high (16/19) when all three methods were used.
• Dynamic ventriculography was crucial, as its omission led to misdiagnosis in 3 initial cases.

Conclusions:

• Comprehensive angiographic evaluation, including conventional and dynamic ventriculography plus coronary angiography, enables accurate LVA diagnosis.
• The term LVA should be reserved for anatomical aneurysms.
• For functional LVA, differentiating reversible from irreversible wall motion abnormalities is key.