Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 4, Number 6, December 2013, pages 178-185

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

**Table 1.** Baseline Characteristics According to Degree of Ischemia (n = 503)
	Mild ischemia n = 230 (46%)	Mod /Sev ischemia n = 273 (54%)	P
Mean age (years) (SD)	69 (± 11)	68 (± 11)	0.18
Age > 65 years	148 (64%)	165 (60%)	0.41
Male gender	182 (79%)	215 (79%)	1.00
Hypertension	198 (86%)	225 (82%)	0.27
Hyperlipidemia	187 (81%)	212 (78%)	0.19
Diabetes	79 (34%)	85 (31%)	0.45
History of smoking	131 (57%)	168 (62%)	0.32
Previous MI	93 (40%)	113 (41%)	0.86
Previous CVA	31 (13%)	25 (9%)	0.15
Previous TIA	8 (3%)	8 (3%)	0.80
PVD	39 (17%)	56 (21%)	0.36
Chronic renal failure	19 (8%)	31 (11%)	0.30
Mean creatinine (SD)	1.3 mg/dL (± 0.8 mg/dL)	1.3 mg/dL (± 0.7 mg/dL)	0.87
Dialysis	5 (2%)	2 (1%)	0.26
Atrial fibrillation/flutter	47 (20%)	39 (14%)	0.07
Prior revascularization	109 (47%)	110 (40%)	0.13
Aspirin	175 (76%)	205 (75%)	0.75
Clopidogrel	49 (21%)	51 (19%)	0.50
Warfarin	33 (14%)	20 (7%)	0.01
Betablocker	157 (68%)	177 (65%)	0.39
ACE inh/ARB	125 (54%)	142 (52%)	0.59
Statin	160 (70%)	181 (66%)	0.44
Diuretic (loop or thiazide)	70 (30%)	86 (32%)	0.85
Aldosterone antagonist	6 (3%)	6 (2%)	0.78
Calcium channel blocker	44 (19%)	61 (22%)	0.44
Digoxin	16 (7%)	10 (4%)	0.11
Echo
EF (mean, SD)	58% (14)	58% (13)	0.78
EF > 50%	168 (73%)	201 (74%)	0.68
WMA	115 (50%)	127 (47%)	0.47
≤ 3 segments	25 (11%)	21 (9%)	0.33
≤ 6 segments	37 (16%)	46 (17%)	0.59
> 6 segments	36 (16%)	42 (15%)	0.78
Diffusely hypokinetic	17 (7%)	18 (7%)	1.00
Nuclear
Summed Rest Score	16 (± 9)	12 (± 7)	< 0.001
Summed Stress Score	19 (± 9)	18 (± 7)	0.53
Summed Difference Score	3 (± 3)	7 (± 4)	< 0.001
Revascularization	79 (34%)	167 (61%)	< 0.001
Death	31 (13%)	33 (12%)	0.69

Table 1. Baseline Characteristics According to Degree of Ischemia (n = 503)

Mild ischemia n = 230 (46%)

Mod /Sev ischemia n = 273 (54%)

Mean age (years) (SD)

69 (± 11)

68 (± 11)

0.18

Age > 65 years

148 (64%)

165 (60%)

0.41

Male gender

182 (79%)

215 (79%)

1.00

Hypertension

198 (86%)

225 (82%)

0.27

Hyperlipidemia

187 (81%)

212 (78%)

0.19

Diabetes

79 (34%)

85 (31%)

0.45

History of smoking

131 (57%)

168 (62%)

0.32

Previous MI

93 (40%)

113 (41%)

0.86

Previous CVA

31 (13%)

25 (9%)

0.15

Previous TIA

8 (3%)

0.80

PVD

39 (17%)

56 (21%)

0.36

Chronic renal failure

19 (8%)

31 (11%)

0.30

Mean creatinine (SD)

1.3 mg/dL (± 0.8 mg/dL)

1.3 mg/dL (± 0.7 mg/dL)

0.87

Dialysis

5 (2%)

2 (1%)

0.26

Atrial fibrillation/flutter

47 (20%)

39 (14%)

0.07

Prior revascularization

109 (47%)

110 (40%)

0.13

Aspirin

175 (76%)

205 (75%)

0.75

Clopidogrel

49 (21%)

51 (19%)

0.50

Warfarin

33 (14%)

20 (7%)

0.01

Betablocker

157 (68%)

177 (65%)

0.39

ACE inh/ARB

125 (54%)

142 (52%)

0.59

Statin

160 (70%)

181 (66%)

0.44

Diuretic (loop or thiazide)

70 (30%)

86 (32%)

0.85

Aldosterone antagonist

6 (3%)

6 (2%)

0.78

Calcium channel blocker

44 (19%)

61 (22%)

0.44

Digoxin

16 (7%)

10 (4%)

0.11

Echo

EF (mean, SD)

58% (14)

58% (13)

0.78

EF > 50%

168 (73%)

201 (74%)

0.68

WMA

115 (50%)

127 (47%)

0.47

≤ 3 segments

25 (11%)

21 (9%)

0.33

≤ 6 segments

37 (16%)

46 (17%)

0.59

> 6 segments

36 (16%)

42 (15%)

0.78

Diffusely hypokinetic

17 (7%)

18 (7%)

1.00

Nuclear

Summed Rest Score

16 (± 9)

12 (± 7)

< 0.001

Summed Stress Score

19 (± 9)

18 (± 7)

0.53

Summed Difference Score

3 (± 3)

7 (± 4)

< 0.001

Revascularization

79 (34%)

167 (61%)

< 0.001

Death

31 (13%)

33 (12%)

0.69

**Table 2.** Summary of Revascularization and Outcomes According to Degree of Ischemia and WMAs (n = 503)
Eighteen patients who were revascularized subsequently died.
	Mild ischemia and no WMA (n = 115)	Mild ischemia and WMA (n = 115)	P value
Prior revascularization	50 (43%)	59 (51%)	0.29
Revascularization	47 (41%)	32 (28%)	0.05
Death	11 (10%)	20 (17%)	0.12

	Moderate/severe ischemia and no WMA (n = 146)	Moderate/severe ischemia and WMA (n = 127)	P value
Prior revascularization	45 (31%)	65 (51%)	0.001
Revascularization	98 (68%)	69 (54%)	0.03
Death	10 (7%)	23 (18%)	0.005

Table 2. Summary of Revascularization and Outcomes According to Degree of Ischemia and WMAs (n = 503)

Eighteen patients who were revascularized subsequently died.

Mild ischemia and no WMA (n = 115)

Mild ischemia and WMA (n = 115)

P value

Prior revascularization

50 (43%)

59 (51%)

0.29

Revascularization

47 (41%)

32 (28%)

0.05

Death

11 (10%)

20 (17%)

0.12

Moderate/severe ischemia and no WMA (n = 146)

Moderate/severe ischemia and WMA (n = 127)

P value

Prior revascularization

45 (31%)

65 (51%)

0.001

Revascularization

98 (68%)

69 (54%)

0.03

Death

10 (7%)

23 (18%)

0.005

**Table 3.** Summary of Revascularization and Outcomes According to Degree of Ischemia and WMAs in a Subset of Patients With no History of Prior Revascularization (n = 284)
	Mild ischemia and no WMA on Echo (n = 65)	Mild ischemia and WMA on Echo (n = 56)	P value
Ten patients were revascularized and subsequently died.
Revascularization	30 (46%)	20 (36%)	0.27
Death	6 (9%)	10 (18%)	0.19

	Moderate/severe ischemia and no WMA on Echo (n = 100)	Moderate/severe ischemia and WMA on Echo (n = 63)	P value
Revascularization	76 (76%)	41 (65%)	0.22
Death	6 (6%)	12 (19%)	0.01

Table 3. Summary of Revascularization and Outcomes According to Degree of Ischemia and WMAs in a Subset of Patients With no History of Prior Revascularization (n = 284)

Mild ischemia and no WMA on Echo (n = 65)

Mild ischemia and WMA on Echo (n = 56)

P value

Ten patients were revascularized and subsequently died.

Revascularization

30 (46%)

20 (36%)

0.27

Death

6 (9%)

10 (18%)

0.19

Moderate/severe ischemia and no WMA on Echo (n = 100)

Moderate/severe ischemia and WMA on Echo (n = 63)

P value

Revascularization

76 (76%)

41 (65%)

0.22

Death

6 (6%)

12 (19%)

0.01

**Table 4.** A. Extent of WMA on Echo According to Segmental Abnormalities and All Cause Mortality (n = 503) P = 0.01 (ANOVA); B. Extent of WMA on Echo According to Segmental Abnormalities and All Cause Mortality in Patients With Mild Ischemia (n = 230) P = 0.39 (ANOVA); C. Extent of WMA on Echo According to Segmental Abnormalities and All Cause Mortality in Patients With Moderate/Severe Ischemia (n = 273) P = 0.005 (ANOVA)
A	0 (n = 261)	≤ 3 (n = 46)	≤ 6 (n = 83)	> 6 (n = 78)	Diffuse (n = 35)
Dead	21 (8%)	6 (13%)	13 (16%)	16 (21%)	8 (23%)
Alive	240 (92%)	40 (87%)	70 (84%)	62 (79%)	27 (77%)

B	0 (n = 115)	≤ 3 (n = 25)	≤ 6 (n = 37)	> 6 (n = 36)	Diffuse (n = 17)
Dead	11 (10%)	5 (20%)	6 (16%)	5 (14%)	4 (24%)
Alive	104 (90%)	20 (80%)	31 (84%)	31 (86%)	13 (76%)

C	0 (n = 146)	≤ 3 (n = 21)	≤ 6 (n = 46)	> 6 (n = 42)	Diffuse (n = 18)
Dead	10 (7%)	1 (5%)	7 (15%)	11 (26%)	4 (22%)
Alive	136 (93%)	20 (95%)	39 (85%)	31 (74%)	14 (78%)

Table 4. A. Extent of WMA on Echo According to Segmental Abnormalities and All Cause Mortality (n = 503) P = 0.01 (ANOVA); B. Extent of WMA on Echo According to Segmental Abnormalities and All Cause Mortality in Patients With Mild Ischemia (n = 230) P = 0.39 (ANOVA); C. Extent of WMA on Echo According to Segmental Abnormalities and All Cause Mortality in Patients With Moderate/Severe Ischemia (n = 273) P = 0.005 (ANOVA)

0 (n = 261)

≤ 3 (n = 46)

≤ 6 (n = 83)

> 6 (n = 78)

Diffuse (n = 35)

Dead

21 (8%)

6 (13%)

13 (16%)

16 (21%)

8 (23%)

Alive

240 (92%)

40 (87%)

70 (84%)

62 (79%)

27 (77%)

0 (n = 115)

≤ 3 (n = 25)

≤ 6 (n = 37)

> 6 (n = 36)

Diffuse (n = 17)

Dead

11 (10%)

5 (20%)

6 (16%)

5 (14%)

4 (24%)

Alive

104 (90%)

20 (80%)

31 (84%)

31 (86%)

13 (76%)

0 (n = 146)

≤ 3 (n = 21)

≤ 6 (n = 46)

> 6 (n = 42)

Diffuse (n = 18)

Dead

10 (7%)

1 (5%)

7 (15%)

11 (26%)

4 (22%)

Alive

136 (93%)

20 (95%)

39 (85%)

31 (74%)

14 (78%)

**Table 5.** Univariable Analysis
	HR	P value	95% CI
Age	1.053	< 0.001	1.027 - 1.081
Sex	1.242	0.113	0.950 - 1.625
Hypertension	0.919	0.639	0.646 - 1.308
Hypercholesterolemia	1.362	0.021	1.049 - 1.768
Diabetes	0.847	0.191	0.660 - 1.087
CVA	0.641	0.003	0.480 - 0.856
PVD	0.649	0.001	0.503 - 0.838
History of smoking	0.868	0.584	0.523 - 1.440
Prior revascularization	0.896	0.660	0.548 - 1.463
Creatinine	1.293	0.003	1.093 - 1.529
Echo EF >/< 50%	0.339	< 0.001	0.208 - 0.554
Resting WMA	0.459	0.003	0.272 - 0.774
Number of abn segments	1.905	0.013	1.148 - 3.162
Degree of ischemia	1.102	0.437	0.862 - 1.409
SDS	1.003	0.915	0.943 - 1.067

Table 5. Univariable Analysis

P value

95% CI

Age

1.053

< 0.001

1.027 - 1.081

Sex

1.242

0.113

0.950 - 1.625

Hypertension

0.919

0.639

0.646 - 1.308

Hypercholesterolemia

1.362

0.021

1.049 - 1.768

Diabetes

0.847

0.191

0.660 - 1.087

CVA

0.641

0.003

0.480 - 0.856

PVD

0.649

0.001

0.503 - 0.838

History of smoking

0.868

0.584

0.523 - 1.440

Prior revascularization

0.896

0.660

0.548 - 1.463

Creatinine

1.293

0.003

1.093 - 1.529

Echo EF >/< 50%

0.339

< 0.001

0.208 - 0.554

Resting WMA

0.459

0.003

0.272 - 0.774

Number of abn segments

1.905

0.013

1.148 - 3.162

Degree of ischemia

1.102

0.437

0.862 - 1.409

SDS

1.003

0.915

0.943 - 1.067

**Table 6.** Multivariable Analysis (Forward Conditional Model)
	HR	P value	95% CI
Age	1.0	0.001	1.02 - 1.08
Creatinine	1.3	0.008	1.08 - 1.67
Ejection Fraction < 50%	2.2	0.002	1.34 - 3.68
Hypercholesterolemia	1.7	0.037	1.03 - 2.98
CVA	2.1	0.011	1.19 - 3.81
PVD	1.7	0.05	1.00 - 2.83

Table 6. Multivariable Analysis (Forward Conditional Model)

P value

95% CI

Age

1.0

0.001

1.02 - 1.08

Creatinine

1.3

0.008

1.08 - 1.67

Ejection Fraction < 50%

2.2

0.002

1.34 - 3.68

Hypercholesterolemia

1.7

0.037

1.03 - 2.98

CVA

2.1

0.011

1.19 - 3.81

PVD

1.7

0.05

1.00 - 2.83