Relation of dyspnea to left ventricular wall motion disturbances in a population of 67-year-old men.

Dyspnea, a potential early symptom of coronary artery disease and congestive heart failure, was evaluated to establish its relation to left ventricular wall motion abnormalities. A group of 67-year-old men, drawn from the general population of Gothenburg, Sweden, was studied. Acceptable studies by 2-dimensional echocardiography were obtained from 42 of 49 men with dyspnea of presumed cardiac origin, and from 45 randomly selected nondyspneic control subjects. Both groups originated from a random population sample of 644 men. All men with akinesia, not limited to the basal inferolateral segment, were dyspneic. Akinesia (inferolateral segment only) was found in 4 of 45 control subjects (9%). Six of 20 men (30%) with low-grade dyspnea and 5 of 5 men with the most severe grade of dyspnea had 1 or more akinetic segments. The severity of dyspnea was related to regional wall motion disturbances (as classified in 11 anatomic segments [p less than 0.02 to p less than 0.0001]) and to presence and number of akinetic segments (p less than 0.0001). The degree of dyspnea was correlated to anterior (p less than 0.0001) but not inferior akinesia. The regional wall motion disturbances measured by echocardiography still contributed significantly to the explanation of dyspnea when taking into account the presence or absence of clinical coronary artery disease determined from a 12-lead electrocardiogram, the history of angina pectoris and myocardial infarction, and the findings on chest x-ray films. Thus, presumed cardiac dyspnea is a sensitive marker of regional wall motion disturbances. Furthermore, the location of these disturbances may be of importance for the hemodynamic changes leading to cardiac dyspnea.