Prevalence and Prognostic Significance of Wall-Motion Abnormalities in Adults Without Clinically Recognized Cardiovascular Disease

Abstract

Background-Left ventricular wall motion (WM) abnormalities have recognized prognostic significance in patients with coronary or other heart diseases; however, whether abnormal WM predicts adverse events in adults without overt cardiovascular disease has not been assessed. Our objective was to determine whether echocardiographic WM abnormalities predict subsequent cardiovascular events in a population-based sample. Methods and Results-Participants (nϭ2864, mean age 60Ϯ8 years, 64% women) without clinically evident cardiovascular disease in the second Strong Heart Study examination who had complete echocardiographic WM assessment were studied. Echocardiographic assessment revealed that 5% of participants (nϭ140) had focal hypokinesia, and 1.5% (nϭ42) had WM abnormalities. Relationships between WM abnormalities and fatal and nonfatal cardiovascular events (including myocardial infarction, stroke, coronary artery disease, and heart failure; nϭ554) and cardiovascular death (nϭ182) during 8Ϯ2 years follow-up were examined. In Cox regression, after adjustment for age, gender, waist/hip ratio, systolic blood pressure, and diabetes mellitus, segmental WM abnormalities were associated with a 2.5-fold higher risk of cardiovascular events and a 2.6-fold higher risk of cardiovascular death (both PϽ0.0001). In similar multivariable models, global WM abnormalities were associated with a 2.4-fold higher risk of cardiovascular events (Pϭ0.001) and a 3.4-fold higher risk of cardiovascular death (Pϭ0.003). Conclusions-Echocardiographic

Hemodynamic Patterns Identified by Impedance Cardiography Predict Mortality in the General Population: The PREVENCION Study

“…Furthermore, subclinical abnormalities in LV function assessed by echocardiography have been shown to predict all‐cause death in the Framingham Heart Study29 and among Olmsted County residents 30. Similarly, regional myocardial dysfunction detected by echocardiography predicted cardiovascular death in the Strong Heart Study,31 whereas regional myocardial dysfunction measured with cardiac magnetic resonance imaging predicted coronary artery disease–related death in the MESA cohort 32. Whereas these previous studies are valuable, the application of noninvasive imaging is limited by cost and widespread availability.…”

Recognizing Unrecognized Risk

“…In addition, the criteria for assigning subjects into the category of "global dysfunction" are a bit nebulous. The report by Cicala et al 15 is noteworthy for several reasons. First, to our knowledge it is the first populationbased study in which SMAs and global hypokinesis have been analyzed separately and apart from measures of overall systolic function.…”

“…In this issue of Circulation, Cicala and associates 15 examine the prevalence and prognostic significance of echocardiographic segmental and global wall motion abnormalities in American Indian subjects enrolled in the Strong Heart Study who had no history of coronary artery disease (CAD), stroke, or CHF. Subjects, who were 45 to 74 years of age, were also excluded if there was evidence of Q-wave MI at baseline, which further limited the possibility of UMI in this overweight, diabetes-prone population.…”

“…Though not significantly different, risk for cardiovascular death tended to be even higher in subjects with global dysfunction than in those with SMAs. It is disappointing that the qualitative stratification strategy for classifying SMA severity, as outlined in Cicala and colleagues' Methods, 15 is never pursued and that the authors fail to indicate whether there is a relationship between SMA severity/distribution and clinical outcome. In addition, the criteria for assigning subjects into the category of "global dysfunction" are a bit nebulous.…”

Techniques for Detection and Analysis of Tumours from Brain MRI Images: A Review

“…In addition, it has also been recognized that many CVD risk factors are associated with each other. It is also seen that heart wall motion can be an indicator for predicting cardiovascular disease in groups of patients with myocardial infarction (MI), unstable angina, typical chest pain, and congestive heart failure (CHF) [2]. left ventricular contractile abnormalities can be an important manifestation of coronary artery disease.…”