Prognostic Value of Normal Stress Echocardiography in Obese Patients

Abstract

Background. Chest pain is a common problem in obese patients. Because of the body habitus, the results of noninvasive evaluation for CAD may be limited in this group. Methods. We reviewed the records of 1446 consecutive patients who had undergone clinically indicated stress echocardiography (SE). We compared major adverse cardiac events (MACE; myocardial infarction, cardiac intervention, cardiac death, subsequent hospitalization for cardiac events, and emergency department visits) at 1 year in normal weight, overweight, and obese subjects with normal SE. Results. Excluding patients with an abnormal and indeterminate SE and those who were lost to follow-up, a retrospective analysis of 704 patients was performed. There were 366 obese patients (BMI ≥ 30), 196 overweight patients (BMI 25–29.9), and 142 patients with normal BMI (18.5–24.9). There was no MACE in the groups at 1-year follow-up after a normal SE. Conclusions. In obese patients including those with multiple risk factors and symptoms concerning for cardiac ischemia, stress echocardiography is an effective and reliable noninvasive tool for identifying those with a low 1-year risk of cardiac events.

Pulmonary hypertension: the importance of correctly diagnosing the cause

“…In patients with obesity, good quality echocardiographic images can be difficult to obtain, and this was observed for case 1. Indeed, echocardiographic images are classified as being "nondiagnostic" in up to 30% of obese patients [30,31].…”

Stress echocardiography in patients with morbid obesity

“…There are two recently published retrospective studies reporting the use of SE in obese patients that merit discussion. Murphy and coworkers reported on 366 obese patients (any BMI >30kg/m 2 , mean BMI 37.3kg/m 2 ) who underwent SE between 2006 and 2009 ( 10 ). The purpose of this study was to determine the prognostic impact of a normal SE at 1-year follow-up.…”

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

“…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 [?]…”

“…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 [?]…”

“…Murphy et al performed a retrospective chart review on 704 patients to determine the prognostic value of a normal stress echocardiogram in overweight and obese subjects. 17 The study population consisted of 366 obese patients (BMI [?] 30 kg/m 2 ), 196 overweight subjects, (BMI 25.0-29.9 kg/m 2 ), and 142 normal weight patients (BMI 18.5-24.9 kg/m 2 ) The follow-up period was 1 year.…”