Scintiphotographic and electrocardiographic evaluation of left ventricular aneurysm

Scintiphotographic and electrocardiographic findings of 40 patients with transmural myocardial infarction (MI) were studied with the objective of evaluating the value of Tc-99m radionuclide ventriculography (Tc-99m RV), Tl-201 myocardial scintigraphy (Tl-201 MS), and persistent ST elevation on ECG in the diagnosis of associated left ventricular aneurysm (VA). VA was detected on Tc-99m RV in 15 patients (Group I), consisting of 11 with anterior MI and four with inferior MI. For 27 aneurysmal segments observed in Group I, Tl-201 MS showed severely reduced uptake in 19 segments and moderately reduced uptake in the 8 others. Out of the other 25 patients without VA, 19 patients had akinesia (Group II). Tl-201 MS for a total of 34 akinetic segments in Group II showed severely reduced uptake in 2 segments, moderately reduced uptake in 22, and slightly reduced uptake in 10. Persistent ST segment elevation by 1 mm or more was observed in 14 patients of Group I and 12 patients of Group II, with statistically significant differences (p < 0.05). The results indicate: 1) Tc-99m RV and Tl-201 MS are useful in the detection of left VA associated with MI, 2) VA is frequently located in anterior and apical segments, and 3) persistent ST elevation may become an indicator for VA. (Namekawa, K.)