Key result
In patients with moderate/severe myocardial ischemia, a resting wall motion abnormality was associated with higher mortality (18% vs 7%), though it was not an independent predictor of mortality.
Why the study?
Does the presence of a resting wall motion abnormality on transthoracic echocardiography predict mortality in patients with varying degrees of myocardial ischemia on SPECT?
Cohort (n=503)
No
Does the presence of a resting wall motion abnormality on transthoracic echocardiography predict mortality in patients with varying degrees of myocardial ischemia on SPECT?
While resting wall motion abnormalities are associated with higher mortality in patients with moderate/severe ischemia, they are not an independent predictor of mortality when accounting for global left ventricular ejection fraction.
Answers are grounded in this paper and cite their sources.
No independent prognostic role beyond LVEF; leaves open incremental value in moderate/severe ischemia.
BACKGROUND: 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. METHODS: Between 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. RESULTS: Following 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. CONCLUSION: A 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.
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Kilcullen (2013) conducted a cohort in Myocardial ischemia (n=503). Resting wall motion abnormality (WMA) vs. No resting WMA was evaluated on All-cause mortality (moderate/severe ischemia subgroup) (p=0.005). In patients with moderate/severe myocardial ischemia, a resting wall motion abnormality was associated with higher mortality (18% vs 7%), though it was not an independent predictor of mortality.
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