Harvard-Thorndike Laboratory, Boston, MA, USA.
Am J Cardiol. 2011 Mar 15;107(6):949-55. doi: 10.1016/j.amjcard.2010.11.014. Epub 2011 Jan 19.
The prevalence and clinical correlates of left ventricular (LV) wall motion abnormalities (WMAs), associated with morbidity and mortality, have not been well-characterized in the population. Framingham Heart Study Offspring Cohort participants (n = 1,794, 844 men, age 65 ± 9 years) underwent cine cardiovascular magnetic resonance for evaluation of LV function. A subset (n = 1,009, 460 men) underwent cardiac multidetector computed tomography for analysis of coronary artery calcium. The presence of coronary heart disease and heart failure (CHD-HF) were assessed in relation to the presence of WMAs. WMAs were present in 117 participants (6.5%) and were associated with male gender, elevated hemoglobin A1c, LV mass, LV end-diastolic volume, and lower LV ejection fraction. Of the 1,637 participants without CHD-HF, 68 (4.2%) had WMAs. In this group, WMAs were associated with obesity, hypertension, and Framingham coronary heart disease risk score in the age- and gender-adjusted analyses and were associated with male gender and hypertension on multivariate analysis. Most subjects with WMAs were in the greatest coronary artery calcium groups. The presence of coronary artery calcium greater than the seventy-fifth percentile and Agatston score >100 were associated with a greater than twofold risk of WMAs in the age- and gender-adjusted analysis but were no longer significant when additionally adjusted for CHD-HF. Previous Q-wave myocardial infarction was present in 29% of the 117 participants with WMAs. In conclusion, in the present longitudinally followed free-living population, 4.2% of the participants without CHD-HF had WMAs. WMAs were associated with the clinical parameters associated with cardiovascular disease risk. Aggressive risk factor modification may be prudent for subjects with WMAs, particularly those free of clinical CHD-HF.
左心室（LV）壁运动异常（WMAs）的患病率和临床相关性与发病率和死亡率有关，但在人群中尚未得到很好的描述。弗雷明汉心脏研究后代队列参与者（n = 1794，844 名男性，年龄 65 ± 9 岁）接受电影心血管磁共振检查以评估 LV 功能。一部分（n = 1009，460 名男性）接受心脏多层计算机断层扫描分析冠状动脉钙。评估 WMAs 与冠心病和心力衰竭（CHD-HF）的存在之间的关系。117 名参与者（6.5%）存在 WMAs，且与男性性别、糖化血红蛋白升高、LV 质量、LV 舒张末期容积和较低的 LV 射血分数相关。在 1637 名无 CHD-HF 的参与者中，68 名（4.2%）存在 WMAs。在该组中，WMAs 与肥胖、高血压和弗雷明汉冠心病风险评分相关，在年龄和性别调整分析中，WMAs 与男性性别和高血压相关，在多变量分析中也是如此。大多数存在 WMAs 的患者处于冠状动脉钙最大组。在年龄和性别调整分析中，冠状动脉钙大于第 75 百分位数和 Agatston 评分>100 与 WMAs 的风险增加两倍以上相关，但当同时调整 CHD-HF 时，这不再具有统计学意义。117 名存在 WMAs 的参与者中，29% 有先前的 Q 波心肌梗死。总之，在本研究中，4.2%的无 CHD-HF 的参与者存在 WMAs。WMAs 与心血管疾病风险相关的临床参数相关。对于存在 WMAs 的患者，特别是那些没有临床 CHD-HF 的患者，积极的危险因素修正可能是明智的。
