Assessment of myocardial ischemia in obese individuals undergoing physical stress echocardiography (PSE)

Silveira, Mara Graziele Maciel; Sousa, Antônio Carlos Sobral; Santos, Marcos César de Oliveira; Tavares, Irlaneide da Silva; Andrade, Stephanie Macedo; Melo, Luiza Dantas; Andrade, Loren Suyane Oliveira de; Santos, Emmanuel Lima Almeida; Oliveira, Joselina Luzia Menezes

doi:10.5935/abc.20150006

Cited by 5 publications

(16 citation statements)

References 27 publications

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“…Only 10% patients received ultrasound contrast in this study. Silveira and coworkers reported on the use of SE in 945 obese patients (BMI >30kg/m 2 ) over a 12-year period ( 11 ). However, in this study no apical three-chamber images were acquired, 37% ‘patients’ were in fact defined as asymptomatic (thus unclear why SE was being performed) and over half of the patients did not attain >85% of the age-predicted target HR.…”

Section: Comparison With Other Echocardiographic Studiesmentioning

confidence: 99%

Stress echocardiography in patients with morbid obesity

Shah

Senior

2016

Echo Res Pract

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The incidence of significant obesity is rising across the globe. These patients often have a clustering of cardiovascular risk factors and are frequently referred for noninvasive cardiac imaging tests. Stress echocardiography (SE) is widely used for assessment of patients with known or suspected coronary artery disease (CAD), but its clinical utility in morbidly obese patients (in whom image quality may suffer due to body habitus) has been largely unknown. The recently published Stress Ultrasonography in Morbid Obesity (SUMO) study has shown that SE, when performed appropriately with ultrasound contrast agents (whether performed with physiological or pharmacological stress), has excellent feasibility and appropriately risk stratifies morbidly obese patients, including identification of patients who require revascularization. This article reviews the evidence supporting the use of echocardiographic techniques in morbidly obese patients for assessment of known or suspected CAD and briefly discusses other noninvasive modalities, including magnetic resonance and nuclear techniques, comparing and contrasting these techniques against SE.

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Section: Comparison With Other Echocardiographic Studiesmentioning

confidence: 99%

Stress echocardiography in patients with morbid obesity

Shah

Senior

2016

Echo Res Pract

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“…Silviera and colleagues performed physical stress echocardiography on 945 obese and 3105 non-obese patients. 16 No significant differences were noted in the incidence of myocardial ischemia in obese patients (19.0%) compared to non-obese patients (17.9%). Logistic regression analysis identified age, female gender, diabetes mellitus, and hypertension, but not obesity as predictors of myocardial ischemia.…”

Section: Discussionmentioning

confidence: 82%

“…This is the first study in patients with class III obesity to directly compare the feasibility and interpretability of DSE with and without the use of intravenous contrast enhancement, both cumulatively and on a segment-by-segment basis. [13][14][15][16][17][18][19] The results indicate that in patients with class III obesity, DSE performed using intravenous contrast enhancement is superior to DSE performed without intravenous enhancement, particularly with regard to visualization of the lateral and anterior segments. Moreover, DSE without intravenous contrast was associated with a significantly higher frequency of poor-or non-visualization of [?]…”

Section: Discussionmentioning

confidence: 88%

“…Nine prior studies have evaluated patients with various degrees of obesity with transthoracic exercise stress echocardiography (ESE) or DSE to determine the feasibility of these studies in this population (4 studies), to assess prognosis based on the presence or absence of myocardial ischemia and other CV outcomes (8 studies). [12][13][14][15][16][17][18] or both (3 studies). Lerakis et al studied 611 patients whose BMI was [?]…”

Section: Discussionmentioning

confidence: 99%

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Comparative Feasibility of Dobutamine Stress Echocardiography Performed With and Without Intravenous Contrast in Patients With Class Iii Obesity

Carlino¹,

Kuppuswamy²,

McCray³

et al. 2021

Preprint

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Background: Concern exists regarding adequacy of visualization of stress echocardiograms performed without intravenous contrast in persons with Class III obesity (body mass index ≥ 40 kg/m2). Methods: Dobutamine stress echocardiography (DSE) was performed on 128 candidates for bariatric surgery with class III obesity without chest pain or pre-existent coronary artery disease (CAD). DSE without intravenous contrast was initially performed on 62 patients with class III obesity, then was subsequently was performed with intravenous contrast on 66 patients with class III obesity. Left ventricular (LV) regional wall motion was assessed at baseline and peak stress using the 16-segment model. Results: In the intravenous contrast group 1046 of 1056 LV segments studied (99.1%) were well-visualized and interpretable at baseline and 1044 of 1056 LV segments studied (98.9%) were well-visualized and interpretable at peak stress. In the non-contrast group 905 of 992 segments studied (91.2%) were well-visualized and interpretable at baseline and 886 of 992 segments studied (89.3%) were well-visualized and interpretable at peak stress. A significantly greater number of LV segments were well-visualized and interpretable in the intravenous contrast group than in the group compared to the non-contrast group, at baseline and at peak stress (p < 0.00001 for both). DSE was positive for ischemia in 1 patient. All patients underwent bariatric surgery without cardiovascular complications. Six months after surgery, all patients were alive; none developed cardiovascular events. Conclusion: The use of intravenous contrast during DSE significantly improves visualization and interpretability of LV segments in patients with class III obesity.

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“…For example, a Brazilian national case series of 4050 asymptomatic patients undergoing exercise stress echocardiography has shown a greater prevalence of hypertension, diabetes, dyslipidemia, family history and sedentary lifestyle among obese individuals. However, on multivariate analysis adjusted for confounding factors, obesity has not associated with myocardial ischemia 9 . On the other hand, in patients with acute coronary syndrome, the abdominal circumference measure has associated with recurring angina, but not with other complications during hospitalization 10 .…”

mentioning

confidence: 90%