Key result
Regional wall motion abnormalities linked to ~2-fold higher 5-year mortality.
Why the study?
The long-term prognostic impact of regional wall motion abnormalities after myocardial infarction is less well understood.
Does the presence of regional wall motion abnormalities on echocardiography predict increased mortality in adults undergoing echocardiographic evaluation?
Cohort (n=492,338)
Yes
Does the presence of regional wall motion abnormalities on echocardiography predict increased mortality in adults undergoing echocardiographic evaluation?
In a massive, nationwide echocardiography registry, the presence of any regional wall motion abnormality nearly doubled 5-year mortality, with severe inferior and apical abnormalities carrying the worst long-term prognosis.
WMA on echo was associated with doubled mortality; extends large-scale prognostic data but leaves open incremental value for risk stratification.
BACKGROUND: Regional wall motion abnormalities (WMAs) after myocardial infarction are associated with adverse remodeling and increased mortality in the short to medium term. Their long-term prognostic impact is less well understood. METHODS AND RESULTS: Via the National Echo Database of Australia (2000-2019), we identified normal wall motion versus WMA for each left ventricular wall among 492 338 individuals aged 61.9±17.9 years. The wall motion score index was also calculated. We then examined actual 1- and 5-year mortality, plus adjusted risk of long-term mortality according to WMA status. Overall, 39 346/255 697 men (15.4%) and 17 834/236 641 women (7.5%) had a WMA. The likelihood of a WMA was associated with increasing age and greater systolic/diastolic dysfunction. A defect in the inferior versus anterior wall was the most and least common WMA in men (8.0% and 2.5%) and women (3.3% and 1.1%), respectively. Any WMA increased 5-year mortality from 17.5% to 29.7% in men and from 14.9% to 30.8% in women. Known myocardial infarction (hazard ratio [HR], 0.86 [95% CI, 0.80-0.93]) or revascularization (HR, 0.87 [95% CI, 0.82-0.92]) was independently associated with a better prognosis, whereas men (1.22-fold increase) and those with greater systolic/diastolic dysfunction had a worse prognosis. Among those with any WMA, apical (HR, 1.08 [95% CI, 1.02-1.13]) or inferior (HR, 1.09 [95% CI, 1.04-1.15]) akinesis, dyskinesis or aneurysm, or a wall motion score index >3.0 conveyed the worst prognosis. CONCLUSIONS: In a large real-world clinical cohort, twice as many men as women have a WMA, with inferior WMA the most common. Any WMA confers a poor prognosis, especially inferoapical akinesis/dyskinesis/aneurysm.
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Playford et al. (2023) conducted a cohort in Patients investigated with echocardiography (n=492,338). Regional wall motion abnormalities (WMA) vs. Normal wall motion was evaluated on 5-year all-cause mortality (Increased from 17.5% to 29.7% in men and from 14.9% to 30.8% in women). In a real-world cohort of 492,338 patients, the presence of any regional wall motion abnormality on echocardiography increased 5-year mortality from 17.5% to 29.7% in men and from 14.9% to 30.8% in women.
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