Study of Myocardial Perfusion in Obese Individuals without Known Ischemic Heart Disease

Abstract

BackgroundObesity is associated with an increased risk of type 2 diabetes mellitus (DM), ischemic heart disease (IHD) and cardiovascular mortality. Several studies have demonstrated the diagnostic and prognostic value of single photon computed tomography-myocardial perfusion scintigraphy (SPECT-MPI) in the evaluation of patients with suspected IHD, including in obese population. Data on clinical risk factors and their association with abnormal myocardial perfusion in obese patients are scarce in the Brazilian population.ObjectiveTo determine the factors associated with abnormal myocardial perfusion in obese individuals without known IHD.MethodsWe studied obese patients without known IHD who were referred for evaluation through SPECT-MPI between January 2011 and December 2016. Clinical variables and results of SPECT-MPI were obtained systematically. The distribution of continuous variables was assessed using the Shapiro-Wilk and Shapiro-Francia tests. We used the unpaired Student t test to compare the means of continuous variables with normal distribution and the Chi Square test for binomial variables analysis. A p value < 0.05 was considered statistically significant. The association of the clinical variables for the presence of factors associated with abnormal myocardial perfusion was determined by univariate and multivariate logistic regression analysis, and respective odds ratios (OR) and 95% confidence intervals (CI).ResultsThe study sample consisted of 5,526 obese patients. Mean body mass index (BMI) of our patients was 33.9 ± 3.7 kg/m2, 31% had DM, and myocardial perfusion abnormalities was observed in 23% of the total sample. The factors associated with abnormal myocardial perfusion on multivariate analysis were: age (OR: 1.02, 95% CI 1.01-1.03, p < 0.001), DM (OR: 1.57, 95% CI 1.31-1.88, p < 0.001), typical angina before the test (OR: 2.45, 95% CI: 1.82-3.31, p < 0.001), need for pharmacologic stress test (OR: 1.61, 95% CI: 1.26-2.07, p < 0.001), less physical effort evaluated in metabolic equivalents (METs) during the exercise treadmill test (OR: 0.89, 95% CI: 0.85-0.94, p < 0.001) and a lower post-stress left ventricular ejection fraction after stress (LVEF; OR: 0.989, 95% CI: 0.984-0.994, p < 0.001).ConclusionThe factors associated with abnormal myocardial perfusion in obese patients without known IHD were age, DM, presence of typical angina, ventricular dysfunction, and inability to undergo physical stress as clinical variables, in addition to functional capacity during physical stress.

Assessment of electrocardiogram abnormality and associated factors among apparently healthy adult type 2 diabetic patients on follow-up at Jimma Medical Center, Southwest Ethiopia: Cross-sectional study

“…The meta-analysis findings revealed that excess weight is associated with CVDs mortality [ 45 ]. Obesity may also cause abnormal myocardial perfusion among T2DM patients [ 46 ].…”

Imagem Cardiovascular em Pacientes com COVID-19

“…Em resumo, a medicina nuclear é fundamental para o manejo de doenças cardiovasculares. [7][8][9][10][11] na cardiologia clínica de rotina, mas não é a primeira linha de abordagem para pacientes com COVID-19. Apesar disso, seus procedimentos podem eventualmente ajudar no manejo desses pacientes.…”

Comment on Myocardial Perfusion Study in Obese Patients without Known Cardiac Ischemia

“…We congratulate Dippe et al 1 for their work that addressed the role of myocardial scintigraphy in the diagnosis of myocardial ischemia in obese patients. 1 Despite limitations, body mass index (BMI) has been the most used anthropometric tool for assessing nutritional status in adults.…”

“…We congratulate Dippe et al 1 for their work that addressed the role of myocardial scintigraphy in the diagnosis of myocardial ischemia in obese patients. 1 Despite limitations, body mass index (BMI) has been the most used anthropometric tool for assessing nutritional status in adults. 2 Epidemiologic studies have identified high BMI as a risk factor for an expanding set of chronic diseases, including cardiovascular disease and diabetes mellitus.…”