Elhendy et al evaluated the significance of wall motion abnormalities (WMA) identified during exercise echocardiography. These can help to identify a patient who may benefit from more aggressive management. The authors are from the Mayo Clinic in Rochester.


An exercise echocardiography was defined as abnormal if one or both of the following is present:

(1) ischemia

(2) fixed WMA (present at rest and unchanged by exercise)


Locations of wall motion abnormalities – in the distribution of:

(1) the left anterior descending (LAD) artery (anterior, anteroseptal, apical septal, apical anterior, apical lateral, midinferoseptal segments)

(2) the left circumflex artery (lateral and posterior segments)

(3) the right coronary artery (apical inferior, midinferior, basal inferoseptal segments)


The risk of adverse cardiac event (nonfatal AMI or cardiac death) was increased with:

(1) multi-vessel abnormalities (with or without involvemenet of the LAD)

(2) abnormality in the distribution of the left anterior descending artery


Additional risk factors for cardiac events included:

(1) low ejection fraction at rest

(2) exercise workload

(3) percent of ischemic segments at peak exercise

(4) age and gender

(5) hypertension

(6) typical chest pain

(7) smoking

(8) previous myocardial infarction


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