title: Prediction of risk for first age-related cardiovascular events in an elderly population: the incremental value of echocardiography.
abstract: OBJECTIVE
  We sought to determine if echocardiography enhances prediction of first age-related cardiovascular events.
  
  
  BACKGROUND
  Whether echocardiographic assessment improves risk stratification for first cardiovascular events is not well known.
  
  
  METHODS
  This retrospective cohort study included randomly selected residents of Olmsted County, Minnesota, age >/=65 years, who had >/=1 transthoracic echocardiograms at the Mayo Clinic between 1990 and 1998, in sinus rhythm, without valvular or congenital heart disease, and followed through medical records for first myocardial infarction (MI), coronary revascularization, atrial fibrillation (AF), congestive heart failure (CHF), transient ischemic attack (TIA), stroke, or cardiovascular death. Patients were excluded if they had any of these events before the baseline echocardiogram.
  
  
  RESULTS
  Of 1,160 patients (age 75 +/- 7 years; 746 women) followed for a mean of 3.8 +/- 2.7 years, 333 (29%) first events occurred (70 AF, 67 coronary revascularization procedures, 65 CHF, 48 MI, 38 stroke, 25 TIA, and 20 cardiovascular deaths). In a multivariate model, age (p < 0.001), male gender (p < 0.001), diabetes mellitus (p = 0.005), systemic hypertension (p < 0.001), left atrial volume/body surface area >/=32 ml/m(2) (p = 0.003), left ventricular (LV) mass/height >/=120 g/m (p = 0.014), LV systolic dysfunction (p < 0.001), and LV diastolic dysfunction (p = 0.029) were independent predictors. A risk-scoring algorithm was developed and validated for the prediction of first events. The five-year event-free survival was 90%, 74%, and 50% for low-, medium-, and high-risk groups, respectively.
  
  
  CONCLUSIONS
  Echocardiography enhanced prediction of first cardiovascular events in this referral-based elderly cohort. Its role in risk stratification for primary prevention of these events in the community warrants further investigations.
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Rochester, Minnesota, USA. tsang.teresa@mayo.edu
authors.forename: Teresa S M
authors.initials: TS
authors.lastname: Tsang
authors.forename: Marion E
authors.initials: ME
authors.lastname: Barnes
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Gersh
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Takemoto
authors.forename: A Gabriela
authors.initials: AG
authors.lastname: Rosales
authors.forename: Kent R
authors.initials: KR
authors.lastname: Bailey
authors.forename: James B
authors.initials: JB
authors.lastname: Seward
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D015331:Cohort Studies; D003920:Diabetes Mellitus; D018572:Disease-Free Survival; D004452:Echocardiography / Q000706:statistics & numerical data*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006801:Humans; D006973:Hypertension; D017379:Hypertrophy, Left Ventricular; D008297:Male; D008499:Medical Records; D008910:Minnesota / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors