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Abstract
BackgroundOur aim was to determine whether regional left ventricular (LV) function on a resting transthoracic echo (TTE) provides prognostic information in patients with varying degrees of ischemia on myocardial perfusion imaging.MethodsBetween 2004 - 2009, we identified 503 patients (mean age 69 (SD 11); 79% male) with reversible ischemia on a myocardial SPECT scan who had a TTE within 30 days. We evaluated the rate of subsequent revascularization and death for all patients.ResultsFollowing the SPECT scan and TTE, 246/503(49%) patients underwent revascularization, 64/503 (13%) patients died, 369 (73%) patients had a normal left ventricular ejection fraction (LVEF), 242 (48%) patients had a resting wall motion abnormality (WMA), 21/261 (8%) with no WMA died compared to 43/242 (18%) in patients with a WMA. In patients with a WMA (n = 242) there was no significant difference in mortality when comparing patients with small (< 6 segments) and large (> 6 segments) WMA (P = 0.44). In patients with moderate/severe ischemia, the presence of a resting WMA was associated with a higher mortality rate (18% v 7%; P = 0.005). In a multivariable model, LVEF (< 50%) was associated with a hazard ratio of 2.2 (P = 0.002, 95% CI 1.34 - 3.68) however, WMA and number of abnormal segments did not reach statistical significance.ConclusionA resting wall motion abnormality in patients with moderate/severe ischemia is associated with a higher mortality compared to patients with mild ischemia on myocardial perfusion imaging. Regional left ventricular dysfunction unlike LVEF was not an independent predictor of mortality.
Highlights
Global left ventricular systolic function as measured by left ventricular ejection fraction (LVEF) is a powerful predictor of outcome [1,2,3,4,5]
Manuscript accepted for publication January 29, 2013
Baseline characteristics for all patients according to degree of ischemia are presented in Table 1, 369 (73%) patients had a normal LVEF, 242 (48%) patients had a wall motion abnormality (WMA)
Summary
Global left ventricular systolic function as measured by left ventricular ejection fraction (LVEF) is a powerful predictor of outcome [1,2,3,4,5]. Regional left ventricular systolic dysfunction as represented by the presence of a resting wall motion abnormality (WMA) is associated with a higher cardiovascular event rate [11, 13,14,15,16,17,18,19] It is unclear whether the prognostic value of the resting WMA relates to the severity of inducible myocardial ischemia or prior infarcts. Our aim was to determine whether regional left ventricular (LV) function on a resting transthoracic echo (TTE) could differentiate those with varying degrees of inducible ischemia and or provide prognostic information in these patients. Our aim was to determine whether regional left ventricular (LV) function on a resting transthoracic echo (TTE) provides prognostic information in patients with varying degrees of ischemia on myocardial perfusion imaging
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