Clinical research in cardiology : official journal of the German Cardiac Society · 2026
Diagnostic and prognostic value of regional wall motion abnormalities in patients with non-ST-elevation myocardial infarction.
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Altstidl J Michael, Achenbach Stephan, Günes-Altan Merve, Moshage Maximilian, Weidinger Florian, Huber Katharina, Tröbs Monique, Marwan Mohamed, Gaede Luise
Аннотация
BACKGROUND: Beyond global left ventricular function, identification of regional wall motion abnormalities (RWMA) is an essential component of emergency echocardiography in patients with non-ST-elevation myocardial infarction (NSTEMI). This study investigated the prognostic significance and diagnostic value of RWMA.
METHODS: Echocardiographies of 1110 consecutive NSTEMI patients undergoing coronary angiography were analyzed. Patients were classified as type 1 NSTEMI if an atherosclerotic culprit lesion was identified, otherwise as type 2. Adverse in-hospital events were a composite of in-hospital death, cardiogenic shock, and mechanical ventilation.
RESULTS: Among 895 patients with type 1 NSTEMI and 215 with type 2, RWMA were present in 68.2% overall. Adverse in-hospital events occurred in 18.1% of patients with RWMA versus 10.5% without (OR 1.89, 95% CI 1.29-2.81). Mediation analysis showed this excess risk was largely attributable to reduced ejection fraction. RWMA occurred more frequently in type 1 compared with type 2 NSTEMI (70.3% vs. 59.5%, p = 0.003) and remained an independent predictor of type 1 NSTEMI (OR 1.69, p = 0.002). However, the diagnostic accuracy of RWMA alone was modest (AUC 0.554), improving to fair performance (AUC 0.727) when combined with clinical factors. Among type 1 NSTEMI patients, RWMA corresponded to the culprit lesion territory in 90.1% when present.
CONCLUSIONS: RWMA identify NSTEMI patients at higher risk of adverse outcomes. Although insufficient alone to differentiate type 1 from type 2 NSTEMI, RWMA augment diagnostic accuracy when combined with clinical factors. Routine RWMA assessment during emergency evaluation may help guide the urgency of invasive management and anticipate the culprit lesion location.
METHODS: Echocardiographies of 1110 consecutive NSTEMI patients undergoing coronary angiography were analyzed. Patients were classified as type 1 NSTEMI if an atherosclerotic culprit lesion was identified, otherwise as type 2. Adverse in-hospital events were a composite of in-hospital death, cardiogenic shock, and mechanical ventilation.
RESULTS: Among 895 patients with type 1 NSTEMI and 215 with type 2, RWMA were present in 68.2% overall. Adverse in-hospital events occurred in 18.1% of patients with RWMA versus 10.5% without (OR 1.89, 95% CI 1.29-2.81). Mediation analysis showed this excess risk was largely attributable to reduced ejection fraction. RWMA occurred more frequently in type 1 compared with type 2 NSTEMI (70.3% vs. 59.5%, p = 0.003) and remained an independent predictor of type 1 NSTEMI (OR 1.69, p = 0.002). However, the diagnostic accuracy of RWMA alone was modest (AUC 0.554), improving to fair performance (AUC 0.727) when combined with clinical factors. Among type 1 NSTEMI patients, RWMA corresponded to the culprit lesion territory in 90.1% when present.
CONCLUSIONS: RWMA identify NSTEMI patients at higher risk of adverse outcomes. Although insufficient alone to differentiate type 1 from type 2 NSTEMI, RWMA augment diagnostic accuracy when combined with clinical factors. Routine RWMA assessment during emergency evaluation may help guide the urgency of invasive management and anticipate the culprit lesion location.