Prevalence and prognostic significance of wall-motion abnormalities in adults without clinically recognized cardiovascular disease - The strong heart study

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.