Prediction of risk for first age-related cardiovascular events in an elderly population: The incremental value of echocardiography

OBJECTIVES: 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/m² (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.