Prognostic Value of T1/T2 Mapping in Post-Infarction Left Ventricular Aneurysm for Determining Surgical Strategy: Dor Procedure vs. Linear Repair

Introduction
Post‑infarction left ventricular aneurysm (LVA) is a challenging complication. Choosing between the Dor procedure (endoventricular patch plasty) and linear repair (aneurysmectomy) depends on fibrosis and viability. Cardiac magnetic resonance (CMR) with T1/T2 mapping enables non‑invasive tissue characterization to guide surgical planning. We assessed the prognostic value of native T1, T2, and extracellular volume (ECV) for predicting functional outcomes after LVA repair.
Methods
We retrospectively studied 48 patients with anterior post‑infarction LVA who underwent preoperative CMR (1.5T/3.0T, 2020–2025). The protocol included functional sequences, late gadolinium enhancement, T1 mapping (MOLLI), T2 mapping (T2‑prep bSSFP) and ECV calculation. Two surgical groups: Dor (n=26) and linear repair (n=22). Primary endpoints: Change in left ventricular end‑systolic volume index (LVESVi) and ejection fraction (LVEF) at 12 months. ROC analysis identified mapping thresholds predictive of favorable response.
Results
LVA volume correlated with native T1 (r=0.54, p<0.001) and ECV (r=0.61, p<0.001). Patients with native T1 ≥1200 ms and ECV ≥32% in the border zone had greater LVESVi reduction (−27±11% vs. −9±8%, p<0.01) and LVEF improvement (+13±6% vs. +5±4%, p<0.01) after Dor versus linear repair. T2 ≤55 ms (mature scar) yielded comparable outcomes regardless of technique. Elevated T2 (>60 ms) in the border zone predicted higher recurrent heart failure after linear repair (OR 3.2, 95% CI 1.4–7.3, p=0.005). ROC analysis identified a native T1 threshold of 1185 ms (AUC 0.83) and an ECV of 30.5% (AUC 0.79) for superior response to Dor. Multivariable regression confirmed mapping parameters as independent predictors (p<0.05).
Conclusions
Preoperative T1/T2 mapping guides require a choice between Dor and linear repair for post‑infarction LVA. Higher native T1 and ECV in the border zone favor Dor, while mature scar with normal T2 suggests acceptable results with linear repair. Incorporating parametric mapping into surgical decision‑making may improve functional outcomes.