Key result
Clinical assessment and dobutamine echocardiography predicted long-term cardiac events in African Americans, with event rates increasing from 13% with 0 predictors to 57% with 4 predictors.
Why the study?
Does clinical assessment combined with rest and stress echocardiography predict long-term prognosis in African Americans with known or suspected coronary artery disease?
Cohort (n=324)
Does clinical assessment combined with rest and stress echocardiography predict long-term prognosis in African Americans with known or suspected coronary artery disease?
Clinical assessment combined with rest and dobutamine stress echocardiography can accurately predict long-term prognosis in African Americans with known or suspected coronary artery disease.
May aid risk stratification in African Americans with suspected CAD; leaves open need for prospective validation before practice change.
BACKGROUND: There is limited information on noninvasive risk stratification of African Americans, a high-risk group for cardiovascular events. We investigated the value of clinical assessment and echocardiography for the prediction of a long-term prognosis in African Americans. METHODS: Dobutamine echocardiography was performed in 324 African Americans. Two-dimensional measurements were performed at rest, and rest and stress wall motion was assessed. A retrospective follow-up was conducted for cardiac events: myocardial infarction (MI) or cardiac death (CD). RESULTS: The mean age was 59 +/- 12 years, and 83% of patients had hypertension. The follow-up was obtained in 318 (98%) patients for a mean of 5.3 years. The events occurred in 107 (33%) subjects. The independent predictors of events were history of MI (P = 0.001, risk ratio [RR] 2.04), ischemia (P = 0.007, RR 1.97), fractional shortening (P = 0.033, RR 0.08), and left atrial (LA) dimension (P = 0.034, RR 1.39). An LA size of 3.6 cm and a fractional shortening of 0.30 were the best cutoff values for the prediction of events. Prior MI, ischemia, LA size >3.6 cm, and fractional shortening <0.30 were each considered independent risk predictors for events. The event rates were 13%, 21%, 38%, 59%, and 57% in patients with 0, 1, 2, 3, and 4 risk predictors, respectively. Event-free survival progressively worsened with an increasing number of predictors: 0 or 1 versus 2 predictors, P < 0.001; 2 versus 3 or 4 predictors, P = 0.003. CONCLUSION: The long-term prognosis of African Americans can be accurately predicted by clinical assessment combined with rest and stress echocardiography.
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Sawada et al. (2009) conducted a cohort in Known or suspected coronary artery disease (n=324). Clinical assessment and dobutamine echocardiography was evaluated on Myocardial infarction (MI) or cardiac death (CD). Clinical assessment and dobutamine echocardiography predicted long-term cardiac events in African Americans, with event rates increasing from 13% with 0 predictors to 57% with 4 predictors.
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