Abstract
BackgroundAfrican 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.MethodsWe 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.ResultsAA 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 ≥ 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.ConclusionThis 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.
Highlights
African Americans (AA) have higher rates of cardiovascular morbidity and mortality than Caucasians (CA)
AA patients were younger (69.4 ± 12.6 years vs. 74.2 ± 10.7 years, p < .001), had higher rates of diabetes mellitus (37% vs. 29%, p = .01), and hypertension (91% vs. 85%, p = .006) at baseline compared to CA patients (Table 1)
Our study found that AA patients were more likely to suffer from non-fatal myocardial infarction (MI) and any Major adverse cardiac events (MACE) compared to CA patients, despite a negative dobutamine stress echocardiography (NDSE)
Summary
African Americans (AA) have higher rates of cardiovascular morbidity and mortality than Caucasians (CA). Though there is data demonstrating that AA patients have a lower incidence of obstructive coronary artery disease (CAD) compared to Caucasian (CA) patients [15], they still have significant rates of myocardial infarction and other cardiac events This has been partially attributed to a difference in the pathology of coronary arteriosclerosis in AA's compared to CA's. Prior studies have shown that AA's have a higher prevalence of traditional cardiovascular risk factors [13,14], that collectively play a role causing dysfunction at the microvasculature level, and thereby contribute to endothelial dysfunction These factors concurrently with an unstable plaque may play a role in higher events rather than the continuing progression of coronary artery plaque build-up as seen in CA's [16]. This dissimilarity in pathology between the 2 groups could have potential implications when interpreting diagnostic stress tests performed to rule out CAD
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
