title: The prognostic value of dobutamine stress echocardiography amongst British Indian Asian and Afro-Caribbean patients: a comparison with European white patients.
abstract: BACKGROUND
  The incidence of cardiovascular disease is considerably disparate among different racial and ethnic populations. While dobutamine stress echocardiography (DSE) has been shown to be useful in Caucasian patients, its role among ethnic minority groups remains unclear. This study aimed to investigate the prognostic importance of DSE in three ethnic groups in the UK.
  
  
  METHODS
  DSE was performed on 6231 consecutive patients. After exclusions, 5329 patients formed the study (2676 [50.2%] Indian Asian, 2219 [41.6%] European white and 434 [8.1%] Afro-Caribbean). Study outcome measures were non-fatal cardiac events (NFCE) and all-cause mortality.
  
  
  RESULTS
  There were 849 (15.9%) NFCE and 1365 (25.6%) deaths over a median follow-up period of 4.6 years. In total 1174 (22%) patients had inducible myocardial ischaemia during DSE, 859 (16.1%) had fixed wall motion abnormalities and 3645 (68.4%) patients had a normal study. Ethnicity did not predict events. Among the three ethnic groups, ischaemia on DSE was associated with 2 to 2.5 times the risk of non-fatal cardiac events and 1.2 to 1.4 times the risk of all-cause mortality. Peak wall motion score index was the strongest independent predictor of non-fatal cardiac events and all-cause mortality in all groups. The C statistic for the prediction of NFCE and all-cause mortality were significantly higher when DSE parameters were added to the standard risk factors for all ethnic groups.
  
  
  CONCLUSIONS
  DSE is a strong predictor of NFCE and all-cause mortality and provides predictive information beyond that provided by standard risk factors in three major racial and ethnic groups. No major differences among racial and ethnic groups in the predictive value of DSE was detected.
authors.affiliation: Department of Cardiology, St George's Healthcare NHS Trust, Blackshaw Road, Tooting, SW17 0QT, London.
authors.forename: Jamie M
authors.initials: JM
authors.lastname: O'Driscoll
authors.affiliation: Department of Cardiology, St George's Healthcare NHS Trust, Blackshaw Road, Tooting, SW17 0QT, London.
authors.forename: Claire
authors.initials: C
authors.lastname: Rossato
authors.affiliation: Department of Cardiology, St George's Healthcare NHS Trust, Blackshaw Road, Tooting, SW17 0QT, London.
authors.forename: Paula
authors.initials: P
authors.lastname: Gargallo-Fernandez
authors.affiliation: Department of Cardiology, St George's Healthcare NHS Trust, Blackshaw Road, Tooting, SW17 0QT, London.
authors.forename: Marco
authors.initials: M
authors.lastname: Araco
authors.affiliation: Department of Cardiology, St George's Healthcare NHS Trust, Blackshaw Road, Tooting, SW17 0QT, London.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Giannoglou
authors.affiliation: Department of Cardiology, St George's Healthcare NHS Trust, Blackshaw Road, Tooting, SW17 0QT, London.|St George's, University of London, Cranmer Terrace, SW17 0RE, London.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Department of Cardiology, St George's Healthcare NHS Trust, Blackshaw Road, Tooting, SW17 0QT, London. rajan.sharma@stgeorges.nhs.uk.
authors.forename: Rajan
authors.initials: R
authors.lastname: Sharma
mesh_terms: D044466:Asian People / Q000706:statistics & numerical data*; D044383:Black People; D017691:Caribbean Region / Q000208:ethnology; D004280:Dobutamine; D004452:Echocardiography / Q000706:statistics & numerical data; D025401:Echocardiography, Stress / Q000706:statistics & numerical data*; D005060:Europe / Q000208:ethnology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000208:ethnology / Q000401:mortality*; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate; D006113:United Kingdom / Q000208:ethnology; D014665:Vasodilator Agents; D044465:White People / Q000706:statistics & numerical data*
chemical_list: D014665:Vasodilator Agents; D004280:Dobutamine