Abstract: Objective：To compare the prognostic value of left ventricular (LV) remodeling parameters determined by gated single photon emission computed tomography (SPECT), gated positron emission tomography (PET) and cardiac magnetic resonance (CMR) in patients with LV aneurysm, and to evaluate the impact of myocardial viability and LV remodeling on the longterm cardiac survival in patients with LV aneurysm.Methods：One hundred and twentysix consecutive patients underwent gated SPECT myocardial perfusion imaging, gated PET metabolic imaging, and CMR within two weeks, with a mean followup of （3.9±1.5） years were enrolled. Patients were divided into three groups by aneurysmal viability (MMS of aneurysm ≥ 2.0) and LV remodeling (ESVI by gatedPET > 60 mL/m2). Group 1 (viability－, LV remodeling－); Group 2 (viability－, LV remodeling+) and Group 3 (viability+, LV remodeling+/-).Results：ESVI by gatedPET (HR 1.024, 95% CI 1.0111.037, P=0.000 4), MMS of aneurysm (HR 1.284, 95% CI 1.0511.577, P=0.015) by interaction analysis were shown to be independent predictors for cardiac death (P<0.05). The longterm cardiac survival was significantly improved by revascularization in comparison with medical therapy in Group 3 (P<0.01), but did not significantly differ between Groups 1 and 2.Conclusions：ESVI by gatedPET showed a significant positive predictive value for cardiac death. Patients with viable myocardial aneurysm were most likely at increased risk for cardiac death and coronary revascularization was significantly associated with improved longterm cardiac survival. In contrast, the longterm cardiac survival of patients without LV remodeling and without aneurysmal viability was promising and, thus, could be treated by medical therapy.