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(Circulation. 2007;116:143-150.)
© 2007 American Heart Association, Inc.

Epidemiology

Prevalence and Prognostic Significance of Wall-Motion Abnormalities in Adults Without Clinically Recognized Cardiovascular Disease

The Strong Heart Study

Silvana Cicala, MD, PhD; Giovanni de Simone, MD; Mary J. Roman, MD; Lyle G. Best, MD; Elisa T. Lee, PhD; Wenyu Wang, PhD; Thomas K. Welty, MD; James M. Galloway, MD; Barbara V. Howard, PhD; Richard B. Devereux, MD

From the Greenberg Division of Cardiology (S.C., G.d.S., M.J.R., R.B.D.), Weill Cornell Medical College, New York, NY; Department of Clinical and Experimental Medicine (S.C., G.d.S.), Federico II University of Naples, Naples, Italy; Missouri Breaks Industries Research, Inc (L.G.B., T.K.W.), Timber Lake, SD; The University of Oklahoma School of Public Health Services (E.T.L., W.W.), Oklahoma City, Okla; University of Arizona Health Sciences Center (J.M.G.), Tucson, Ariz; and MedStar Research Institute (B.V.H.), Washington, DC.

Correspondence to Richard B. Devereux, MD, Division of Cardiology, New York Presbyterian Hospital-Weill Medical College of Cornell University, 525 E 68th St, New York, NY 10021. E-mail rbdevere{at}med.cornell.edu

Received July 18, 2006; accepted May 1, 2007.

Background— Left ventricular wall motion (WM) abnormalities have recognized prognostic significance in patients with coronary or other heart diseases; however, whether abnormal WM predicts adverse events in adults without overt cardiovascular disease has not been assessed. Our objective was to determine whether echocardiographic WM abnormalities predict subsequent cardiovascular events in a population-based sample.

Methods and Results— Participants (n=2864, mean age 60±8 years, 64% women) without clinically evident cardiovascular disease in the second Strong Heart Study examination who had complete echocardiographic WM assessment were studied. Echocardiographic assessment revealed that 5% of participants (n=140) had focal hypokinesia, and 1.5% (n=42) had WM abnormalities. Relationships between WM abnormalities and fatal and nonfatal cardiovascular events (including myocardial infarction, stroke, coronary artery disease, and heart failure; n=554) and cardiovascular death (n=182) during 8±2 years follow-up were examined. In Cox regression, after adjustment for age, gender, waist/hip ratio, systolic blood pressure, and diabetes mellitus, segmental WM abnormalities were associated with a 2.5-fold higher risk of cardiovascular events and a 2.6-fold higher risk of cardiovascular death (both P<0.0001). In similar multivariable models, global WM abnormalities were associated with a 2.4-fold higher risk of cardiovascular events (P=0.001) and a 3.4-fold higher risk of cardiovascular death (P=0.003).

Conclusions— Echocardiographic left ventricular WM abnormalities in adults without overt cardiovascular disease are associated with 2.4- to 3.4-fold higher risks of cardiovascular morbidity and mortality, independent of established risk factors.

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CLINICAL PERSPECTIVE

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