Significance of resting wall motion abnormalities in 2-dimensional echocardiography in patients without previous myocardial infarction referred for pharmacologic stress testing

Abstract

Background: Resting wall motion abnormalities (WMA) in 2-dimensional echocardiography may be encountered in patients without previous myocardial infarction or known coronary artery disease (CAD) who are referred for stress testing. However, the functional significance of these abnormalities has not been evaluated by an independent technique. The goals of this study were to assess the value of resting WMA in the prediction of an ischemic response during dobutamine stress testing independent of other clinical characteristics in patients without known CAD, and to evaluate whether the presence of resting WMA is related to the presence or extent of myocardial perfusion abnormalities during dobutamine stress testing.Methods: We studied 116 patients (mean age 57 ± 13 years, 50 men) without known CAD or a history of myocardial infarction by dobutamine-atropine (dobutamine: <-40 μg/kg/min; atropine: <-1 mg) stress echocardiography and simultaneous stress and rest technetium sestamibi single-photon emission computed tomography imaging. Ischemia was defined as new or worsening wall motion abnormalities and reversible perfusion defects, respectively.Results: Resting WMA were detected in 24 patients (21%). Patients with resting WMA had a higher prevalence of abnormal perfusion (75% vs 25%, P < .001) and a higher prevalence of ischemia by single-photon emission computed tomography (50% vs 24%, P < .05) and by echocardiography (42% vs 9%, P < .001) compared with patients without resting WMA, respectively. Stress and rest perfusion defect scores were significantly higher in patients with than in those without rest WMA (3.25 ± 2.67 vs 0.88 ± 1.77, P < .0001; and 1.46 ± 1.69 vs 0.21 ± 0.70, P < .0001; respectively). Independent predictors of the occurrence of ischemia by echocardiography were the presence of resting WMA (P < .01, χ2 = 6.7), ST-segment depression (P < .005, χ2 = 11.3), and angina during the test (P < .05, χ2 = 5.3) by using multivariate analysis of clinical and stress test variables. The presence of resting WMA was the only independent predictor of an abnormal perfusion (P < .0001, χ2 = 20).Conclusion: The presence of resting WMA in patients without known CAD or a previous myocardial infarction who were referred for pharmacologic stress testing is highly predictive of abnormal myocardial perfusion. Resting WMA are powerful independent predictors of an ischemic response during dobutamine stress testing and identify a population with a higher prevalence and extent of myocardial perfusion abnormalities.