Long-term survival and prognostic factors in patients with postinfarction left ventricular aneurysm on conservative management

Abstract

Objective. To analyze the 5-year survival outcomes and identify factors associated with adverse prognosis in patients with postinfarction left ventricular aneurysm undergoing conservative management.

Material and methods. A retrospective analysis was conducted on 150 patients with post-infarction left ventricular aneurysm (PILVA) who were monitored at the A.N. Bakulev National Medical Research Center for Cardiovascular Surgery (2018–2023). The study cohort was divided into groups: favorable outcome (n=131) and fatal outcome (n=19). Clinical- functional, laboratory, and instrumental parameters were evaluated, including echocardiography, ECG, and biochemical markers. The Kaplan–Meier method was used for survival analysis, and prognostic factors were studied using the Cox model and ROC analysis.

Results. The 5-year survival rate was 77.7% (95% CI 66.1–91.4). Adverse outcomes were associated with significant left ventricular remodeling (end-diastolic volume index ≥124 ml/m², end-systolic volume index ≥59 ml/m²), reduction in stroke index (≤41 ml/m²), mitral regurgitation ≥3 degrees (p=0.014), and heart failure NYHA class III–IV (OR 3.65; p=0.033). Laboratory risk markers included a decrease in hemoglobin (OR 0.960; p=0.035) and sodium (OR 0.770; p=0.019). The developed prognostic model (QRS + end-systolic volume index (ESVI)) demonstrated AUC=0.766 (p=0.002).

Conclusion. The study demonstrated that the 5-year survival rate in patients with postinfarction left ventricular aneurysm was 77.7% (95% CI 66.1–91.4). Univariate analysis identified the following as independent predictors of five-year mortality in the studied patient population: decreased stroke volume index, hemoglobin level, and serum sodium, as well as increased QRS complex duration, end-diastolic volume index, and end-systolic volume index. Significant risk factors also included the presence of mitral regurgitation and chronic heart failure of NYHA functional class III–IV.