Abstract 3574: Unsuspected Left Ventricular Wall Motion Abnormalities Identified by Cardiovascular Magnetic Resonance in a Free-Living Population: Lessons from the Framingham Heart Study

Abstract

INTRODUCTION: Resting left ventricular (LV) wall motion abnormalities (WMAs) are associated with significant morbidity and mortality. We hypothesized that unsuspected resting WMAs would be present in a healthy population and applied cardiovascular magnetic resonance (CMR) to characterize the prevalence of these in a free-living population. METHODS: 1794 subjects in the Framingham Heart Study Offspring Cohort (844M, 65±9 yrs) underwent cine CMR in short-axis, 2-ch, and 4-ch planes. Wall motion was scored using a standard 17-segment model with a 5-point scale. Global and regional (Ant, Sept, Inf, Lat) wall motion score indices (WMSI=wall motion score/# segments) were calculated with a WMSI>1 considered abnormal. LV ejection fraction (EF) and mass index (LVMI) were measured from the short axis stack. Adjudicated clinical events [CE; a history of coronary heart disease (CHD) or congestive heart failure (CHF)] were assessed. RESULTS: WMAs were present in 143 subjects. Compared to subjects with no prior CE, those with CE (n=157) had greater prevalence of WMA (Global, 34% vs 6%; Ant, 16% vs 2%; Sept, 18% vs 3%; Inf, 28% vs 4%; Lat, 27% vs 3%; all p<0.0001) and higher Framingham Risk Score (FRS) (11±3 vs 7±4, p<0.0001). In subjects with CE, WMA was associated with higher LVMI (70±14 g/m 2 vs 59±14 g/m 2 , p<0.0001) and lower EF (53±11% vs 69±6%, p<0.0001), but not age, blood pressure (BP), or FRS. Among 1637 subjects with no CE, 90 (5.5%) had a WMA. In these subjects, WMA was associated with greater age, BP, FRS, and LVMI, and lower EF (TABLE ). In the entire (n=1794) cohort, WMAs were more prevalent in men than in women (40% vs 19% with CE; 9% vs 3% without CE, respectively, both p<0.0001). CONCLUSIONS: In this closely followed free-living population, 5.5% of subjects have WMAs despite the absence of CE. WMAs were associated with other parameters of cardiovascular risk. The presence of WMAs among subjects without history of CHD or CHF may identify those at risk for adverse cardiovascular events.