Feasibility and Prognostic Value of Stress Echocardiography in Obese, Morbidly Obese, and Super Obese Patients Referred for Bariatric Surgery

Supariwala, Azhar; Makani, Harikrishna; Kahan, Jonathan; Pierce, Matthew; Bajwa, Farhan; Dukkipati, Sai Sreenija; Teixeira, Júlio; Chaudhry, Farooq A.

doi:10.1111/echo.12481

Cited by 27 publications

(26 citation statements)

References 35 publications

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“…Two studies have evaluated the feasibility of transthoracic SE in obese patients awaiting bariatric surgery. Both studies showed excellent feasibility with contrast echocardiography 8 9. Our present findings extend the results of the previous two studies as our study was prospective and multicentre in design and, importantly, evaluated the performance of SE in a ‘real-world’ clinical service with obese patients referred for assessment of known or suspected CAD, not just specifically for preoperative risk stratification.…”

Section: Discussionsupporting

confidence: 78%

The clinical impact of contemporary stress echocardiography in morbid obesity for the assessment of coronary artery disease

Shah

Zacharias

Pabla

et al. 2016

Heart

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Section: Discussionsupporting

confidence: 78%

The clinical impact of contemporary stress echocardiography in morbid obesity for the assessment of coronary artery disease

Shah

Zacharias

Pabla

et al. 2016

Heart

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“…However, only dobutamine SE was evaluated. More recently, Supariwala and coworkers performed a single-center retrospective analysis in patients with BMI >30kg/m 2 referred for bariatric surgery and also found that just 1% of studies were nondiagnostic, specifically due to poor image quality ( 13 ).…”

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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“…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: 89%

“…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%

“…Six of the previous 9 studies were retrospective and relied heavily on chart review or registry information. 14,[16][17][18][19] Our study was prospective and provided a head-to-head comparison of patients with class III obesity receiving intravenous contrast with those who did not receive intravenous contrast. In prior studies, intravenous contrast was used only when baseline non-intravenous contrast images were unsatisfactory except for the study by Hu et al which focused on overweight and mildly obese patients.…”

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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Feasibility and Prognostic Value of Stress Echocardiography in Obese, Morbidly Obese, and Super Obese Patients Referred for Bariatric Surgery

Abstract: Stress echocardiography is feasible in the morbidly obese patients. Patients with higher BMI were more likely to undergo dobutamine SE and have higher incidence of poor acoustic windows and contrast use.

Cited by 27 publications

References 35 publications

The clinical impact of contemporary stress echocardiography in morbid obesity for the assessment of coronary artery disease

The clinical impact of contemporary stress echocardiography in morbid obesity for the assessment of coronary artery disease

Stress echocardiography in patients with morbid obesity

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

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