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Prognostic implications of negative dobutamine stress echocardiography in African Americans compared to Caucasians
Ajay V Srivastava1, Karthik Ananthasubramaniam, Salil J Patel
1Heart and Vascular Institute, Henry Ford Hospital, Detroit, USA. asrivas1@hfhs.org
Insights
African American patients with negative dobutamine stress echocardiography have worse cardiac outcomes than Caucasians. This highlights the need for closer monitoring and proactive treatment strategies for African American individuals undergoing cardiac evaluations.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Medical Research
Background:
- African Americans (AA) experience higher cardiovascular disease rates than Caucasians (CA).
- The prognostic value of negative dobutamine echocardiography (NDSE) in predicting cardiac events across racial groups is not well understood.
- NDSE has a high negative predictive value for major adverse cardiac events (MACE).
Purpose of the Study:
- To investigate the influence of race on the prognostic implications of NDSE.
- To compare cardiac outcomes between African American and Caucasian patients following NDSE.
Main Methods:
- A study cohort of 387 AA and 340 CA patients with NDSE was analyzed.
- Kaplan-Meier survival analysis was used to assess freedom from MACE over 36 months.
- A Cox proportional-hazards model examined the impact of race on cardiac outcomes.
Main Results:
- AA patients were younger and had higher rates of diabetes, hypertension, and left ventricular hypertrophy compared to CA patients.
- Ejection fraction was similar between groups (81% vs. 82%).
- At 3 years, AA patients showed lower freedom from nonfatal myocardial infarction (92% vs. 96%) and MACE (91% vs. 95%) compared to CA patients.
Conclusions:
- This study is the first to show that AA patients with NDSE have increased rates of nonfatal myocardial infarction and MACE compared to CA patients.
- These findings suggest AA patients with NDSE require closer follow-up.
- Aggressive preventive and treatment strategies are crucial for AA patients to reduce cardiovascular morbidity and mortality despite a negative ischemic workup.
Background:
African Americans (AA) have higher rates of cardiovascular morbidity and mortality than Caucasians (CA). Despite its excellent negative predictive value, the influence of race on the prognostic implications of negative dobutamine echocardiography in predicting major cardiac problems is largely unknown.
Methods:
We studied 387 AA and 340 CA patients with negative dobutamine stress echocardiography (NDSE). Kaplan-Meier survival analysis was used to create freedom-from-event curves for major adverse cardiac events over a 36-month period, and a Cox proportional-hazards multivariable model to examine the influence of race on cardiac outcomes.
Results:
AA patients were younger (69.4 +/- 12.6 vs. 74.2 +/- 10.7, p < .001), had higher incidence of diabetes mellitus (37% vs. 29%, p = .01), hypertension (91% vs. 85%, p = .006), left ventricular hypertrophy (70% vs. 49%, p < .001) and lower incidence of prior coronary artery disease (27% vs. 34%, p = .05) compared to CA patients. Ejection fraction > or = 50% was comparable (81% vs. 82%, p = .8). At 3-years, AA patients had a lower freedom from nonfatal myocardial infarction (92% vs. 96%, p = .006) and any cardiac event (cardiac death, myocardial infarction) (91% vs. 95%, p = .005) compared to CA patients.
Conclusion:
This is the first study to demonstrate that AA patients have higher rates of nonfatal MI and MACE compared to CA patients with a NDSE. These patients require closer follow-up and aggressive preventive and treatment strategies should be employed to help reduce cardiovascular morbidity and mortality despite negative ischemic workup.
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