title: Prevalence and prognostic significance of wall-motion abnormalities in adults without clinically recognized cardiovascular disease: the Strong Heart Study.
abstract: 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.
  
  
  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.
authors.affiliation: Greenberg Division of Cardiology, Weill Medical College of Cornell University, 525 E 68th St, New York, NY 10021, USA.
authors.forename: Silvana
authors.initials: S
authors.lastname: Cicala
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Simone
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Roman
authors.forename: Lyle G
authors.initials: LG
authors.lastname: Best
authors.forename: Elisa T
authors.initials: ET
authors.lastname: Lee
authors.forename: Wenyu
authors.initials: W
authors.lastname: Wang
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Welty
authors.forename: James M
authors.initials: JM
authors.lastname: Galloway
authors.forename: Barbara V
authors.initials: BV
authors.lastname: Howard
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015331:Cohort Studies; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D018754:Ventricular Dysfunction / Q000453:epidemiology*