Electrovectorcardiographic study of ventricular aneurysms in ischemic patients: correlation with imaging methods

Abstract

Ventricular aneurysms are known structural complications resulting from an Acute Myocardial Infarction (AMY). They present a characteristic narrowing and focal dilatation, with akinetic and/or diskinetic deformations during the ventricular systole. The definition of a "true" ventricular aneurysm includes the notion of a wide "neck" and > 0.5 ratio (diameter of the junction between the aneurysm and the rest of the left ventricle, in relation to the maximum diameter of the aneurysm); however, with the advance of imaging methods in cardiology, other terms different from the usual ones have been used to denominate them, like diastolic distortions, even in the absence of an anatomical ventricular aneurysm.Ventricular aneurysms and their variants may be found in up to 60% of patients presenting with ST-segment elevation acute myocardial infarction (STEMI) in whom no spontaneous or therapeutic reperfusion has occurred, while they are found in less than 5% of patients with non-ST-segment myocardial infarction (NSTEMI), which is more related to anterior wall infarctions and MIs involving the anterior descending artery. In Brazil, the mortality due to cardiovascular disease between 2004 and 2014 was 28.73%, nearly 1/3 of them due to ischemic cardiomyopathy, which is its main cause (accessible in http:www.datasus.gov.br). Potential evolution to a clinical picture of congestive heart failure is found in nearly 50% of the patients, with angina affecting up to 33% of them. Thromboembolic events are observed in 50% of diseased patients, while symptomatic ventricular arrhythmias are present in 15%. They stand among the differential diagnoses of a J-point elevation in the horizontal plane leads, which spectrum of pathologies includes an array of therapeutic managements and prognoses. The above reasons substantiate the need for studying and characterizing the different aspects of ventricular aneurysms through the use of a simple and low cost test as the electro-vectorcardiogram. (AU)