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Clinical Assessment and Rest and Stress Echocardiography for Prediction of Long‐Term Prognosis in African Americans with Known or Suspected Coronary Artery Disease
Author(s) -
Sawada Stephen G.,
Sayyed Samer,
Raiesdana Azad,
GradusPizlo Irmina,
Mahenthiran Jothiharan,
Feigenbaum Harvey
Publication year - 2009
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/j.1540-8175.2008.00845.x
Subject(s) - medicine , cardiology , myocardial infarction , coronary artery disease , relative risk , dobutamine , stress echocardiography , risk stratification , cutoff , confidence interval , hemodynamics , physics , quantum mechanics
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.