Prevalence, clinical profile, and prognosis of patients with isolated left ventricular apical wall motion abnormality during stress echocardiography

Abstract Background Isolated regional wall motion abnormality of the left ventricular apex (apical iRWMA) during stress echocardiography is a commonly observed finding. The clinical significance, prognostic impact, and prevalence of this phenomenon have not been extensively studied to date. Purpose The aim of this study was to evaluate the occurrence of apical iRWMA during dobutamine stress echocardiography (DSE), exercise stress echocardiography (ExSE), and dipyridamole stress echocardiography (DIPSE) and to compare the clinical characteristics of patients examined by these methods and the occurrence of anginal pain during the test. Methods The retrospective analysis included 302 consecutive patients investigated for suspected coronary artery disease (CAD) with chest pain or exertional dyspnoea (DSE n=103, ExSE n=99, DIPSE n=100). Apical iRWMA was defined as markedly delayed contraction, hypokinesia, akinesia, or dyskinesia of the 17th segment in the 17-segment LV model. The occurrence of apical iRWMA and the clinical profile of patients (age, gender, diabetes, hypertension, smoking, hyperlipidaemia, and family history of CAD) were assessed in all groups. Major Adverse Cardiovascular Events (MACE) were defined as significant coronary atherosclerosis (≥70% coronary artery stenosis), death, or hospitalization for cardiovascular causes during a five-year follow-up. For statistical analysis, the chi-square test, Fisher's exact test, and the Kruskal-Wallis analysis of variance with Dunn's post-hoc test were used. Results No difference was observed in patients' baseline clinical characteristics among the different examination types, except for older age in patients undergoing DIPSE compared to ExSE [60 (54,69) vs 57 (47,66), p=0.024, Table 1]. Apical iRWMA was detected exclusively in 10.7% of patients undergoing DSE (n=11, p