Choice of Imaging Modality in the Assessment of Coronary Artery Disease Risk in Extreme Obesity

Transradial Versus Transfemoral Artery Approach for Coronary Angiography and Percutaneous Coronary Intervention in the Extremely Obese

“…Patients with EO represent a unique population because they are difficult to evaluate by standard noninvasive testing (14); they have more associated coronary artery disease risk factors; and they have an increased risk of morbidity and mortality from cardiac events (2). Moreover, their risk is compounded at the time of coronary angiography and PCI due to an increased risk of complications.…”

Cardiovascular Magnetic Resonance Imaging—Incremental Value in a Series of 361 Patients Demonstrating Cost Savings and Clinical Benefits: An Outcome-Based Study

“…Examples of these studies included accurate assessment of left ventricular systolic function in obese patients, right ventricular morphology, aortic valve morphology in severely calcific valves, cardiac morphology in congenital heart disease, suspected complications of myocardial infarction including left ventricular pseudoaneurysms, assessment of cardiac masses, differentiating true cardiac masses from artifacts, etc. The growing epidemic of obesity in the United States has significantly increased the incidence of uninterpretable echocardiograms due to attenuation of ultrasound waves 18,19. Other than bore size considerations, obesity does not limit cardiac MRI.…”

BMI does not influence the prediction of cardiac events using stress CMR

“…The difficulty in utilizing echocardiography in the obese patient population is the frequent problem of image quality [2] and, therefore, its prognostic value remains unclear [6]. For SPECT, the utility of the test is restricted in obese patients due to attenuation artifacts or absolute weight [7] and there are conflicting data regarding the prognostic value of a negative SPECT examination in these patients [8].…”

“…CT perfusion and CT coronary angiography can be used for risk stratification. However, these modalities show technical limitations and are associated with higher radiation exposure in obese patients [2,9]. Although the potential of DCMR for detection of CAD has been shown, its prognostic value in dependence of BMI is scarcely known.…”

“…Several imaging modalities are commonly used in the evaluation of cardiac ischemia in the general population. The ideal modality for CAD detection would have high sensitivity and specificity, meaning that a negative result would correctly identify patients with a very low cardiac event rate [2], independent of body weight. In a recent study, vasodilator stress cardiovascular magnetic resonance (CMR) was reported as showing prognostic value in a small group of obese patients [3].…”