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CLINICAL STUDY: CLINICAL APPLICATION OF ECHOCARDIOGRAPHIC FINDINGS

Prognostic significance of the location of wall motion abnormalities during exercise echocardiography

Abdou Elhendy, MD, PhD^*, Douglas W. Mahoney, MSc, Bijoy K. Khandheria, MD, FACC^*, Timothy E. Paterick, MD^*, Kelli N. Burger, BSc and Patricia A. Pellikka, MD, FACC^*,*

^* Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
Section of Biostatistics, Mayo Clinic, Rochester, MinnesotaUSA

Manuscript received January 23, 2002; revised manuscript received May 16, 2002, accepted June 24, 2002.

^* Reprint requests and correspondence: Dr. Patricia A. Pellikka, Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905, USA.
pellikka.patricia{at}mayo.edu

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.

Abbreviations and Acronyms   CAD   coronary artery disease   LAD   left anterior descending   LCX   left circumflex artery   METs   metabolic equivalents   MI   myocardial infarction   RCA   right coronary artery   WMA   wall motion abnormality

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