Clinical and Imaging Findings in 504 Cases With Left Ventricular Pseudoaneurysm Following Myocardial Infarction: A Comprehensive Systematic Review and Meta-Analysis.

BACKGROUND: Left ventricular pseudoaneurysm (LVPA) is a rare but life-threatening complication of myocardial infarction (MI). We pooled clinical and imaging findings of post-MI LVPA reported in case reports/series and compared them with findings in post-MI left ventricular aneurysm (LVA). METHOD: We comprehensively searched the literature published since 1991 on online databases. Individual-level patient data (IPD) and aggregated-level data (AD) studies were combined through a two-stage meta-analysis method. RESULTS: We identified 379 eligible articles on LVPA (N = 504 patients). LVPA patients were predominantly male (70.4%) with a mean age of 65.4 years (95% CI: 62.4, 68.4). The time interval between the last MI and the diagnosis of LVPA varied from one day to 20 years; 54.5% fell into the acute/subacute category. On echocardiography, the most frequent locations of LVPA were posterior (34.5%) and inferior (21.2%). The average dimensions were 5.7 and 7.3 cm. On MRI, late gadolinium enhancement, primarily pericardial, was observed in 84% of patients. Arrhythmia was more frequently observed in LVA than LVPA (33.8% vs. 1%). Echocardiography showed a lower diagnostic value in LVPA than LVA (sensitivity: 81.4% vs. 97.5%). A higher percentage of LVPA than the LVA group died during hospitalization (13.8% vs. 4.7%) or after discharge (17.5% vs. 9.0%). CONCLUSION: LVPA is probably located on the posterior and inferior segments in most patients, contrary to LVA, which mainly involves the anterior and apical segments. Arrhythmia is likely a common clinical finding in LVA but not LVPA. Echocardiography may not always detect LVPA in 20% of patients.