title: The Prognostic Significance of Resting Regional Left Ventricular Function in Patients With Varying Degrees of Myocardial Ischemia.
abstract: BACKGROUND
  Our 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.
  
  
  METHODS
  Between 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.
  
  
  RESULTS
  Following 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.
  
  
  CONCLUSIONS
  A 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.
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, USA.
authors.forename: Niamh M
authors.initials: NM
authors.lastname: Kilcullen
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, USA.
authors.forename: Shanmugan
authors.initials: S
authors.lastname: Uthamalingam
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, USA.
authors.forename: Gagandeep S
authors.initials: GS
authors.lastname: Gurm
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, USA.
authors.forename: Shawn A
authors.initials: SA
authors.lastname: Gregory
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, USA.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Picard
keywords: Ischemic heart disease; Transthoracic echocardiography; Wall motion