No, Outland and Northrend are left virtually untouched. The pre-Cataclysm patch actually adds all the new level 1-60 content at no cost to those with Wrath or TBC. It's a good buy for people getting into the game right now since they get a much better leveling experience and Cataclysm related content without having to buy Cataclysm.
Storylines in Kalimdor and Eastern Kingdoms will assume you've killed the Lich King, but if you level up and quest in Northrend, it will be the same as launch day of Wrath.
(PS. One more day to buy WoW digitally from Blizzard cheap - $5 for Classic WoW, $5 for The Burning Crusade, $10 for Wrath.)
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