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.

Keywords: cardiac imaging; obesity; stress echocardiography; ultrasound contrast.

Figure 1

Contrast-enhanced rest (upper panel) and stress (lower panel) end-systolic images from the largest man in the SUMO study (weight 207 kg (456 lbs), BMI 63 kg/m² and BSA 3.2 m²) demonstrating excellent endocardial border visualization in all three apical views. There was no inducible ischemia on this study. Reproduced, with permission, from Shah BN, Zacharias K, Pabla JS, Karogiannis N, Calicchio F, Balaji G, Alhajiri A, Ramzy IS, Elghamaz A, Gurunathan S, et al. (2016) The clinical impact of contemporary stress echocardiography in morbid obesity for the assessment of coronary artery disease, Heart, vol 102, pp 370–375. Copyright 2016 BMJ Publishing Group Ltd and the British Cardiovascular Society (9).