Improving prediction of outcomes in African Americans with normal stress echocardiograms using a risk scoring system

Area of Science:

• Cardiology
• Preventive Medicine
• Medical Informatics

Background:

• Cardiovascular disease (CVD) mortality is disproportionately high in African Americans.
• Even with normal stress echocardiography results, this population exhibits elevated cardiovascular event risk.
• Existing risk stratification tools may not adequately address the specific needs of African Americans undergoing stress echocardiography.

Purpose of the Study:

• To develop and validate a novel risk scoring system.
• To enhance the prediction of cardiovascular events in African Americans with normal stress echocardiography findings.
• To identify key clinical and echocardiographic predictors for improved risk stratification.

Main Methods:

• A cohort of 548 African Americans with normal rest and stress echocardiography (ejection fraction ≥50%) was studied.
• Clinical data and rest echocardiographic measurements were collected.
• Patients were followed for 3 years for myocardial infarction and death, with Cox regression used to identify predictors and derive a risk score.

Main Results:

• During 3-year follow-up, 8.6% of patients experienced cardiovascular events.
• Five independent predictors were identified: age, coronary disease history, smoking history, left ventricular hypertrophy, and exercise intolerance.
• The derived risk score (0-8 points) demonstrated strong predictive ability (Area Under Curve = 0.82), distinguishing high-risk (≥6 points, 30% events) from low-risk (<6 points, 3% events) patients.

Conclusions:

• African Americans with normal stress echocardiography results are at significant risk for cardiovascular events.
• A risk score incorporating clinical and echocardiographic variables effectively stratifies risk in this population.
• This tool can aid in identifying high-risk individuals for targeted preventive strategies.