LIMITATIONS
There are several study limitations. In prior studies, follow-up was
often ≥ 1 year. Our study provided follow-up at 6 months. Our study was
performed prior to the availability of the newest harmonic imaging
technology which could further improve endocardial edge detection and
reduce the need for intravenous contrast.22 We chose
the 16-segment model to assess LV regional wall motion which was
recommended by the American Society of Echocardiography at the time that
this study was performed. The American Heart Association currently
recommends the 17-segment model, adding the atrial cap to the 16-segment
model. Since our sonographers were instructed to use the 16-segment
model at the time of the study, we chose to utilize this model in our
analysis. Since we did not routinely perform coronary angiography on the
patients in our study, we are unable to provide sensitivity,
specificity, and predictive accuracy values. We acknowledge that the
relatively young age and the female predominance of our study population
reduced the likelihood of the presence of severe CAD. Our results may or
may not be applicable to patients with established CAD with a high
incidence of regional wall motion abnormalities. Finally, our study was
prospective, but was not prospectively randomized or matched.
Alpert