OJMI  Vol.2 No.2 , June 2012
Prognostic Utility of Dobutamine Stress Echocardiography in the Obese African American Population
ABSTRACT
Background: The predictive value of Dobutamine Stress Echocardiography (DSE) in the obese African American patient population is not well known. Methods: We conducted a retrospective study of 555 African American patients between 1/1/2001-12/31/2001. DSE responses were classified into normal, ischemia, scar, or scar +/? ischemia. End-points utilized were all cause death (ACD) and major adverse cardiac events (MACE). Results: There were a total of 409 obese patients and 146 non-obese patients. By multi-variate analysis only the scar group in the obese population predicted ACD (p = 0.003) and combined MACE (p = 0.014). Kaplan Meir analysis demonstrated that only the scar group was associated with decrease in freedom from all cause death (p < 0.001) and combined MACE (p < 0.001). Conclusion: DSE retains its prognostic power in the obese African American population and scar has important impli-cations for MACE.

Cite this paper
A. Khan, E. Valdiviezo, G. Singh, S. Kanjanauthai, W. Nazneen and K. Ananthasubramaniam, "Prognostic Utility of Dobutamine Stress Echocardiography in the Obese African American Population," Open Journal of Medical Imaging, Vol. 2 No. 2, 2012, pp. 50-56. doi: 10.4236/ojmi.2012.22009.
References
[1]   E. H. Steinberg, L. Madmon, C. P. Patel, S. P. Sedlis, I. Kronzon and J. L. Cohen. “Long-Term Prognostic Significance of Dobutamine Echocardiography in Patients with Suspected Coronary Artery Disease: Results of a 5-Year Follow-Up Study,” Journal of the American College of Cardiology, Vol. 29, No. 5, 1997, pp. 969-973. doi:10.1016/S0735-1097(97)00032-6

[2]   D. Poldermans, P. M. Fioretti, E. Boersma, J. H. Cornel, F. Borst, E. G. J. Vermeulen, M. Arnese, A. El-Hendy and J. R. T. C. Roelandt, “Dobutamine-Atropine Stress Echocardiography and Clinical Data for Predicting Late Cardiac Events in Patients with Suspected Coronary Artery Disease,” The American Journal of Medicine, Vol. 97, No. 2, 1994, pp. 119-125. doi:10.1016/0002-9343(94)90021-3

[3]   J. Krivokapich, J. S. Child, D. O. Walter and A. Garfinkel. “Prognostic Value of Dobutamine Stress Echocardiography in Predicting Cardiac Events in Patients with Known or Suspected Coronary Artery Disease,” Journal of the American College Cardiology, Vol. 33, No. 3, 1999, pp. 708-716. doi:10.1016/S0735-1097(98)00632-9

[4]   S. C. Chuah, P. A. Pellikka, V. L. Roger, R. B. McCully and J. B. Seward, “Role of Dobutamine Stress Echocardiography in Predicting Outcome in 860 Patients with Known or Suspected Coronary Artery Disease,” Circulation, Vol. 97, 1998, pp. 1474-1480.

[5]   L. J. Shaw, C. Vasey, S. Sawada, C. Rimmerman and T. H. Marwick, “Impact of Gender on Risk Stratification by Exercise and Dobutamine Stress Echocardiography: LongTerm Mortality in 4234 Women and 6898 Men,” European Heart Journal, Vol. 26, No. 5, 2005, pp. 447456. doi:10.1093/eurheartj/ehi102

[6]   L. Cortigiani, R. Bigi, R. Sicari, P. Landi, F. Bovenzi and E. Picano, “Prognostic Value of Pharmacological Stress Echocardiography in Diabetic and Nondiabetic Patients with Known or Suspected Coronary Artery Disease,” Journal of the American College of Cardiology, Vol. 47, No. 3, 2006, pp. 605-610. doi:10.1016/j.jacc.2005.09.035

[7]   R. F. Gillum and K. C. Liu, “Coronary Heart Disease Mortality in United States Blacks, 1940-1978: Trends and Unanswered Questions,” American Heart Journal, Vol. 108, No. 3, 1984, pp. 728-732. doi:10.1016/0002-8703(84)90665-3

[8]   A. V. Srivastava, K. Ananthasubramaniam, S. J. Patel, N. Lingam and G. Jacobsen, “Prognostic Implications of Negative Dobutamine Stress Echocardiography in African Americans Compared to Caucasians,” Cardiovascular Ultrasound, Vol. 6, No. 20, 2008. doi:10.1186/1476-7120-6-20

[9]   O. O. Akinboboye, O. Idris, A. Onwuanyi, K. Berekashvili and S. R. Bergmann, “Incidence of Major Cardiovascular Events in Black Patients with Normal Myocardial Stress Perfusion Study Results,” Journal of Nuclear Cardiology, Vol. 8, No. 5, 2001, pp. 541-547. doi:10.1067/mnc.2001.116497

[10]   L. J. Shaw, R. C. Hendel, M. Cerquiera, J. H. Mieres, N. Alazraki, E. Krawczynska, S. Borges-Neto, J. Maddahi and C. N. B. Merz, “Ethnic Differences in the Prognostic Value of Stress Technetium-99m Tetrofosmin Gated Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging,” Journal of the American College Cardiology, Vol. 45, No. 9, 2005, pp. 1494-1504. doi:10.1016/j.jacc.2005.01.036

[11]   A. Alkeylani, D. D. Miller, L. J. Shaw, M. I. Travin, H. G. Stratmann, R. Jenkins and G. V. Heller, “Influence of Race on the Prediction of Cardiac Events with Stress Technetium-99m Sestamibi Tomographic Imaging in Patients with Stable Angina Pectoris,” American Journal of Cardiology, Vol. 81, No. 3, 1998, pp. 293-297. doi:10.1016/S0002-9149(97)00896-5

[12]   P. Poirier, T. D. Giles, G. A. Bray, Y. L. Hong, J. S. Stern, F. X. Pi-Sunyer and R. H. Eckel, “Obesity and Cardiovascular Disease: Pathophysiology, Evaluation, and Effect of Weight Loss: An Update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism,” Circulation, Vol. 113, 2006, pp. 898-918. doi:10.1161/CIRCULATIONAHA.106.171016

[13]   R. M. Krauss, M. Winston, B. J. Fletcher and S. M. Grundy, “Obesity: Impact of Cardiovascular Disease,” Circulation, Vol. 98, 1998, pp. 1472-1476.

[14]   R. H. Eckel, “Obesity and Heart Disease: A Statement for Healthcare Professionals from the Nutrition Committee, American Heart Association,” Circulation, Vol. 96, 1997, pp. 3248-3250.

[15]   J. E. Manson, W. C. Willett, M. J. Stampfer, G. A. Colditz, D. J. Hunter, S. E. Hankinson, C. H. Hennekens and F. E. Speizer, “Body Weight and Mortality among Women,” The New England Journal of Medicine, Vol. 333, 1995, pp. 677-685. doi:10.1056/NEJM199509143331101

[16]   E. E. Calle, M. J. Thun, J. M. Petrelli, C. Rodriguez, C. W. Heath Jr., “Body-Mass Index and Mortality in a Prospective Cohort of U.S. Adults,” The New England Journal of Medicine, Vol. 341, 1999, pp. 1097-1105. doi:10.1056/NEJM199910073411501

[17]   S. J. Hu, S. X. Liu, H. A. Katus and M. Luedde, ”The Value of Contrast Dobutamine Stress Echocardiography in Detecting Coronary Artery Disease in Overweight and Obese Patients,” Canadian Journal of Cardiology, Vol. 23, No. 11, 2007, pp. 885-889. doi:10.1016/S0828-282X(07)70844-9

[18]   S. G. Sawada, S. Sayyed, A. Raiesdana, I. Gradus-Pizlo, J. Mahenthiran and H. Feigenbaum, “Clinical Assessment and Rest and Stress Echocardiography for Prediction of Long-Term Prognosis in African Americans with Known or Suspected Coronary Artery Disease,” Echocardiography, Vol. 26, No. 5, 2009, pp. 558-566. doi:10.1111/j.1540-8175.2008.00845.x

[19]   K. Steel, R. Broderick, V. Gandla, E. Larose, F. Resnic, M. Jerosch-Herold, K. A. Brown and R. Y. Kwong, “Complementary Prognostic Values of Stress Myocardial Perfusion and Late Gadolinium Enhancement Imaging by Cardiac Magnetic Resonance in Patients with Known or Suspected Coronary Artery Disease,” Circulation, Vol. 120, 2009, pp. 1390-1400. doi:10.1161/CIRCULATIONAHA.108.812503

[20]   D. Poldermans, P. M. Fioretti, E. Boersma, J. J. Bax, I. R. Thomson, J. R. T. C. Roelandt and M. L. Simoons, “Long-Term Prognostic Value of Dobutamine-Atropine Stress Echocardiography in 1737 Patients with Known or Suspected Coronary Artery Disease: A Single-Center Experience,” Circulation, Vol. 99, 1999, pp. 757-762.

[21]   S. B. Labib, M. Goldstein, P. M. Kinnunen and E. C. Schick, “Cardiac Events in Patients with Negative Maximal versus Negative Submaximal Dobutamine Echocardiograms Undergoing Noncardiac Surgery: Importance of Resting Wall Motion Abnormalities,” Journal of the American College Cardiology, Vol. 44, No. 1, 2004, pp. 82-87. doi:10.1016/j.jacc.2004.03.049

[22]   R. Y. Kwong, H. Sattar, H. Wu, G. Vorobiof, V. Gandla, K. Steel, S. Siu and K. A. Brown, “Incidence and Prognostic Implication of Unrecognized Myocardial Scar Characterized by Cardiac Magnetic Resonance in Diabetic Patients without Clinical Evidence of Myocardial Infarction,” Circulation, Vol. 118, 2008, pp. 1011-1020. doi:10.1161/CIRCULATIONAHA.107.727826

[23]   L. Cortigiani, E. Picano, C. Coletta, F. Chiarella, W. Mathias, N. Gandolfo, M. De Alcantara, V. Mazzoni, G. F. Gensini and P. Landi, “Safety, Feasibility, and Prognostic Implications of Pharmacologic Stress Echocardiography in 1482 Patients Evaluated in an Ambulatory Setting,” American Heart Journal, Vol. 141, No. 4, 2001, pp. 621629. doi:10.1067/mhj.2001.113997

[24]   S. Ciaroni, A. Bloch and L. Albrecht, “Prognostic Value of Dobutamine Echocardiography in Elderly Patients with Suspected Coronary Artery Disease and an Abnormal Resting Electrocardiogram,” Echocardiography, Vol. 19, No. 4, 2002, pp. 307-312. doi:10.1046/j.1540-8175.2002.00307.x

 
 
Top