Stress echocardiography in patients with morbid obesity

Abstract

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.

Feasibility of physiologist-led stress echocardiography for the assessment of coronary artery disease

“…Stress echocardiography is a highly operator-dependent technique necessitating high image quality for diagnostic accuracy. We report a similarly very high proportion of diagnostic, completed studies with 16 analysable myocardial segments with PLSE and CLSE (~97%), in keeping with the literature base ( 16 ) and alternative non-invasive functional assessment modalities including vasodilator stress cardiovascular MRI (CMR) ( 17 ) and nuclear single-photon emission computed tomography (SPECT) ( 18 ). This supports our view on the importance of a robust training period in stress echocardiography image acquisition and optimisation before commencing a PLSE service.…”

Echocardiographic assessment of myocardial ischemia

“…In general, when 3DE is used for stress examination, if the heart rate is >110 beats/min [we need >130 beats/min from the prognostic perspective (20)], the acquisition of a sufficient number of volumes per heart cycle becomes a problem. An additional problem can be the acoustic window for echocardiography when a safe answer for decision making regarding interventional procedures is needed (91,92). In these cases, an additional imaging technology, such as CMR or single-photon emission computed tomography (SPECT), is needed.…”

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

“…4 In patients with mildly-to-moderate obesity, standard methods of stress testing can be performed with an acceptable sensitivity, specificity, and predictive accuracy. [5][6][7][8][9] In patients with extreme (Class III) obesity there are limitations associated with standard stress testing modalities. [5][6][7][8][9] Poor functional capacity may limit the effectiveness of stress tests that employ treadmill exercise.…”

“…[5][6][7][8][9] In patients with extreme (Class III) obesity there are limitations associated with standard stress testing modalities. [5][6][7][8][9] Poor functional capacity may limit the effectiveness of stress tests that employ treadmill exercise. 3,5,[7][8][9] Excessive attenuation and weight restrictions may interfere with the ability to obtain accurate pharmacologic myocardial perfusion scans.…”

“…[5][6][7][8][9] Poor functional capacity may limit the effectiveness of stress tests that employ treadmill exercise. 3,5,[7][8][9] Excessive attenuation and weight restrictions may interfere with the ability to obtain accurate pharmacologic myocardial perfusion scans. 7,9 Weight and size limitations and cost considerations cause stress cardiac magnetic resonance imaging to be used infrequently in patients with class III obesity.…”