Cardiac catheterization in morbidly obese patients

Abstract

The safety and findings of cardiac catheterization and coronary angiography in morbidly obese patients with suspected coronary heart disease (CHD) have not been fully examined in the modern era. From a database of 4,978 patients undergoing diagnostic cardiac catheterization, we identified 110 with morbid obesity (body mass > or = 145 kg and body mass index > or = 40 kg/m(2)). Relative to all the other patients in this database, morbidly obese patients had a lower prevalence of CHD (45% vs. 72%; P < 0.05), reflecting a higher prevalence of false positive noninvasive tests. Overall, noninvasive tests were only 75% sensitive and 39% specific for CHD in this group. Use of radial access (66%) and femoral closure devices (24%) was much more frequent in the morbidly obese cohort. Complications were no more frequent in the morbidly obese group, with major (0 vs. 0.9%) and minor (4.7% vs. 3.5%) adverse outcomes being similar to the rest of the database. We conclude that cardiac catheterization using the radial artery or a femoral closure device is a safe and effective method of evaluating CHD in morbidly obese patients. In contrast, noninvasive testing is frequently not definitive and may be misleading.

2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease

“…1178,1179 Because of limitations in exercise testing and challenges with imaging through increased breast tissue or chest girth, reduced diagnostic accuracy has been reported for obese patients. 1180 Because of breast tissue artifact, myocardial perfusion PET is more accurate than myocardial perfusion SPECT for the obese patient, 191,193,323 although attenuation-correction algorithms or prone imaging can help improve myocardial perfusion SPECT accuracy. 187,188 Intravenous contrast enhancement improves image quality in obese patients and results in improved diagnostic certainty for stress echocardiography.…”

Obesity and Cardiovascular Disease: Pathophysiology, Evaluation, and Effect of Weight Loss

“…235 Nevertheless, in severe obesity, a higher incidence of false-positive noninvasive functional tests for the detection of CHD is seen. 235,236 Transesophageal echocardiography may be of diagnostic use in the evaluation of the presence of CHD in severely obese individuals. Transesophageal dobutamine stress echocardiography combines the advantages of pharmacological stress testing with superior-quality cardiac imaging, has been reported to be safe, and appears to be a good alternative to cardiac catheterization for assessing the presence of CHD and ischemic threshold in morbidly obese patients.…”

“…Alternatively, the percutaneous radial approach has numerous advantages in the very obese patient because the frequency of complications with the use of this technique is very low. 236,238 …”

Optimizing care for the obese patient in interventional radiology

“…For all patients, radial access is associated with decreased major hemorrhagic complications (50,51). Radial access may be especially important in reducing access complications (52) and is the strongest independent predictor of low vascular complications in obese patient, with an odds ratio of 0.12 (49).…”