The Prognostic Significance of Resting Regional Left Ventricular Function in Patients With Varying Degrees of Myocardial Ischemia

Abstract

BackgroundOur 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.MethodsBetween 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.ResultsFollowing 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.ConclusionA 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.

Predictors of segmental myocardial functional recovery in patients after an acute ST-Elevation myocardial infarction

“…Our results support the emerging role of strain imaging as a reference method for the assessment of regional myocardial contractility post-MI and for prognostication of regional LV function during longer-term follow-up. Whilst this does not equate with a prognostic advantage, an improvement in segmental myocardial function assessed with WMS is associated with a reduction in all-cause mortality and heart failure hospitalization [[33], [34], [35]].…”

Prognostic value of summed motion score assessed by gated SPECT myocardial perfusion imaging in patients with dilated cardiomyopathy

“…Our study also showed a reduction in LVEF in the HSMS group compared to the LSMS group (21.5% vs. 12.0%, P < 0.001). However, LVEF reflects the global function, and the hypercontractile cardiomyopathy segments may offset the hypokinetic cardiomyopathy segments, thereby preserving total LV systolic function ( 42 ). Studies have reported that WSMI is a stronger powerful predictor of adverse cardiac outcomes in patients with acute myocardial infarction ( 43 – 45 ).…”