Key result
Inducible myocardial ischaemia during dobutamine stress echocardiography was associated with a 2 to 2.5-fold increased risk of non-fatal cardiac events across Afro-Caribbean, European white, and Indian Asian patients.
Why the study?
The role and prognostic value of dobutamine stress echocardiography among ethnic minority groups in the UK remained unclear compared to its established use in Caucasian patients.
Does dobutamine stress echocardiography predict non-fatal cardiac events and all-cause mortality in British Indian Asian, Afro-Caribbean, and European white patients?
Cohort (n=5,329)
Single-blind
No
Does dobutamine stress echocardiography predict non-fatal cardiac events and all-cause mortality in British Indian Asian, Afro-Caribbean, and European white patients?
Dobutamine stress echocardiography provides strong prognostic information for cardiac events and mortality beyond standard risk factors, with similar predictive value across Indian Asian, Afro-Caribbean, and European white patients.
BACKGROUND: The incidence of cardiovascular disease is considerably disparate among different racial and ethnic populations. While dobutamine stress echocardiography (DSE) has been shown to be useful in Caucasian patients, its role among ethnic minority groups remains unclear. This study aimed to investigate the prognostic importance of DSE in three ethnic groups in the UK. METHODS: DSE was performed on 6231 consecutive patients. After exclusions, 5329 patients formed the study (2676 [50.2%] Indian Asian, 2219 [41.6%] European white and 434 [8.1%] Afro-Caribbean). Study outcome measures were non-fatal cardiac events (NFCE) and all-cause mortality. RESULTS: There were 849 (15.9%) NFCE and 1365 (25.6%) deaths over a median follow-up period of 4.6 years. In total 1174 (22%) patients had inducible myocardial ischaemia during DSE, 859 (16.1%) had fixed wall motion abnormalities and 3645 (68.4%) patients had a normal study. Ethnicity did not predict events. Among the three ethnic groups, ischaemia on DSE was associated with 2 to 2.5 times the risk of non-fatal cardiac events and 1.2 to 1.4 times the risk of all-cause mortality. Peak wall motion score index was the strongest independent predictor of non-fatal cardiac events and all-cause mortality in all groups. The C statistic for the prediction of NFCE and all-cause mortality were significantly higher when DSE parameters were added to the standard risk factors for all ethnic groups. CONCLUSIONS: DSE is a strong predictor of NFCE and all-cause mortality and provides predictive information beyond that provided by standard risk factors in three major racial and ethnic groups. No major differences among racial and ethnic groups in the predictive value of DSE was detected.
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O’Driscoll et al. (2015) conducted a cohort in Suspected angina pectoris or shortness of breath on exertion (n=5,329). Myocardial ischaemia on dobutamine stress echocardiography vs. No ischaemia on dobutamine stress echocardiography was evaluated on Non-fatal cardiac events (NFCE) (HR 2.0-2.5, p=<0.001). Inducible myocardial ischaemia during dobutamine stress echocardiography was associated with a 2 to 2.5-fold increased risk of non-fatal cardiac events across Afro-Caribbean, European white, and Indian Asian patients.
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