Document Detail

Prognostic significance of the location of wall motion abnormalities during exercise echocardiography.
MedLine Citation:
PMID:  12427415     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: Our aim was to determine whether location of wall motion abnormalities (WMAs) during exercise echocardiography provides independent prognostic value. BACKGROUND: The effect of the location of WMAs during stress echocardiography on prognostic outcome is unknown. METHODS: We studied 4,347 patients (mean age, 61 +/- 12 years; 2,230 men) with known or suspected coronary artery disease by symptom-limited exercise echocardiography. An abnormal result was defined as resting or exercise-induced WMA. End points were cardiac death and nonfatal myocardial infarction (MI). RESULTS: There were 133 cardiac events (54 cardiac deaths and 79 nonfatal MIs) during follow-up (median, three years). In a multiple-stepwise multivariate analysis model, clinical and exercise electrocardiography predictors of cardiac events were age, gender, hypertension, typical chest pain, previous MI, smoking, and resting ejection fraction. The percentage of ischemic segments at peak exercise provided additional information to the model (p = 0.0001). The presence of abnormalities in the left anterior descending (LAD) coronary artery distribution had an additional independent effect for the prediction of cardiac events (p = 0.001). Among patients with exercise echocardiographic abnormalities in a single vascular region, those with abnormalities in the left anterior descending coronary artery distribution had a higher event rate than patients with abnormalities elsewhere (3.2% vs. 2.1% at three years and 10.8% vs. 2.1% at five years; p = 0.009). CONCLUSIONS; Exercise WMAs in the distribution of the LAD coronary artery are associated with an increased risk of cardiac death and nonfatal MI. This risk is independent of the resting ejection fraction and the extent of WMAs during exercise.
Abdou Elhendy; Douglas W Mahoney; Bijoy K Khandheria; Timothy E Paterick; Kelli N Burger; Patricia A Pellikka
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  40     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2002 Nov 
Date Detail:
Created Date:  2002-11-12     Completed Date:  2003-01-03     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1623-9     Citation Subset:  AIM; IM    
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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MeSH Terms
Coronary Artery Bypass
Coronary Artery Disease / complications,  diagnosis*,  physiopathology,  therapy
Disease-Free Survival
Echocardiography, Stress*
Middle Aged
Multivariate Analysis
Myocardial Contraction
Myocardial Infarction / etiology
Predictive Value of Tests
Retrospective Studies
Risk Factors

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