Document Detail

Clinical assessment and rest and stress echocardiography for prediction of long-term prognosis in African Americans with known or suspected coronary artery disease.
MedLine Citation:
PMID:  19452609     Owner:  NLM     Status:  MEDLINE    
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.
Stephen G Sawada; Samer Sayyed; Azad Raiesdana; Irmina Gradus-Pizlo; Jothiharan Mahenthiran; Harvey Feigenbaum
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Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  Echocardiography (Mount Kisco, N.Y.)     Volume:  26     ISSN:  1540-8175     ISO Abbreviation:  Echocardiography     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-05-18     Completed Date:  2009-07-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8511187     Medline TA:  Echocardiography     Country:  United States    
Other Details:
Languages:  eng     Pagination:  558-66     Citation Subset:  IM    
Department of Medicine, Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana 46202, USA.
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MeSH Terms
African Americans / statistics & numerical data*
Coronary Artery Disease / ethnology*,  ultrasonography*
Dobutamine / diagnostic use*
Echocardiography / statistics & numerical data*
Exercise Test / methods,  statistics & numerical data*
Indiana / ethnology
Longitudinal Studies
Middle Aged
Reproducibility of Results
Risk Assessment / methods
Risk Factors
Sensitivity and Specificity
Reg. No./Substance:

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