Wall-motion abnormalities associated with CV events, even in asymptomatic adults

Shelley Wood

June 22, 2007

New York, NY - Wall-motion abnormalities detected using echocardiography can identify adults with no clinically recognized CVD who are more likely to go on to have cardiovascular events or die of CV disease, a new study shows[1]. The association between wall-motion abnormalities and increased morbidity and mortality was independent of established risk factors, a new analysis of the Strong Heart Study data set suggests.

The study, by Dr Silvana Cicala (Weill Cornell Medical College, New York, NY) and colleagues, was published online June 18, 2007 in Circulation. Senior author Dr Richard B Devereux (Weill Cornell Medical College) explained to heartwire that the significance of wall-motion abnormalities in an unselected population consisting of people with no known cardiovascular disease has not previously been examined, although previous studies have linked wall-motion abnormalities to adverse cardiovascular outcomes in people with acute ischemic heart disease and congestive heart failure.

"We made the logical assumption that the significance of wall-motion abnormalities in people who had previous heart attacks or other diagnoses would apply to other individuals, but unfortunately the history of medicine is littered with many examples where reasonable assumptions don't hold true," he said.

To test their hypothesis, Cicala, Devereux, et al used data from the Strong Heart Study, conducted in American Indian populations. In all, 2864 men and women, mean age 60, who did not have clinical symptoms of CVD, underwent echocardiography as part of the study; 1.5% of this cohort were found to have wall-motion abnormalities. In Cox regression analyses, segmental wall-motion abnormalities were associated with a 2.5-fold increase in cardiovascular events and a slightly higher increase of CV death, even after adjustment for age, gender, systolic blood pressure, waist/hip ratio, and diabetes. Global wall-motion abnormalities carried an apparent 2.4-fold higher risk of cardiovascular events, while the risk of CV death was associated with a hazard ratio of 3.4, after similar adjustment for confounding factors.

Risks associated with global wall-motion abnormalities*

End point Adjusted hazard ratio p
Any CV event 2.4 0.001
MI 1 0.97
Stroke 3.1 0.06
Coronary heart disease 1.9 0.07
Heart failure 3.1 0.003
CV mortality 3.4 0.003
*Compared with no abnormalities

To heartwire , Devereux acknowledged that while it is not feasible or appropriate to universally screen asymptomatic populations using echocardiography, the study still has important clinical implications.

"Echocardiograms are done in large numbers of people for a wide variety of reasons—palpitations, chest pain, or when electrocardiogram findings are nondiagnostic of anything specific," he said. "What our findings say is, if one does do an echocardiogram without a clear diagnosis of CVD and does find a wall-motion abnormality, that identifies individuals who are at increased risk and probably have underlying coronary artery disease. And certainly in my own practice I would target those individuals for aggressive control of blood pressure and use that additional evidence to try to get people to stop smoking and do other things that are beneficial."

The findings might also stimulate the initiation of preventive treatments that had not previously seemed warranted, he said.

Future studies should assess whether patients undergoing treatment for hypertension or other cardiovascular conditions but not, primarily, for CAD, experience improvements in wall-motion abnormalities as a result of treatment and whether these improvements have prognostic implications in terms of underlying coronary disease, Devereux said.

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