Legault Sylvie, Sénéchal Mario, Bergeron Sébastien, Arsenault Marie, Tessier Michel, Guimond Jean, Poirier Paul
Department of cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, Canada.
Cardiovasc Ultrasound. 2010 Jul 28;8:30. doi: 10.1186/1476-7120-8-30.
Severe obesity is associated with an increased risk of coronary artery disease (CAD). Bariatric surgery is an effective procedure for long term weight management as well as reduction of comorbidities. Preoperative evaluation of cardiac operative risk may often be necessary but unfortunately standard imaging techniques are often suboptimal in these subjects. The purpose of this study was to demonstrate the feasibility, safety and utility of transesophageal dobutamine stress echocardiography (TE-DSE) using an adapted accelerated dobutamine infusion protocol in severely obese subjects with comorbidities being evaluated for bariatric surgery for assessing the presence of myocardial ischemia.
Subjects with severe obesity [body mass index (BMI) >40 kg/m2] with known or suspected CAD and being evaluated for bariatric surgery were recruited.
Twenty subjects (9M/11F), aged 50 +/- 8 years (mean +/- SD), weighing 141 +/- 21 kg and with a BMI of 50 +/- 5 kg/m2 were enrolled in the study and underwent a TE-DSE. The accelerated dobutamine infusion protocol used was well tolerated. Eighteen (90%) subjects reached their target heart rate with a mean intubation time of 13 +/- 4 minutes. Mean dobutamine dose was 31.5 +/- 9.9 ug/kg/min while mean atropine dose was 0.5 +/- 0.3 mg. TE-DSE was well tolerated by all subjects without complications including no significant arrhythmia, hypotension or reduction in blood arterial saturation. Two subjects had abnormal TE-DSE suggestive of myocardial ischemia. All patients underwent bariatric surgery with no documented cardiovascular complications.
TE-DSE using an accelerated infusion protocol is a safe and well tolerated imaging technique for the evaluation of suspected myocardial ischemia and cardiac operative risk in severely obese patients awaiting bariatric surgery. Moreover, the absence of myocardial ischemia on TE-DSE correlates well with a low operative risk of cardiac event.
重度肥胖与冠状动脉疾病（CAD）风险增加相关。减肥手术是长期体重管理以及减少合并症的有效方法。术前评估心脏手术风险通常很有必要，但遗憾的是，标准成像技术在这些患者中往往效果不佳。本研究的目的是证明经食管多巴酚丁胺负荷超声心动图（TE-DSE）在采用适应性加速多巴酚丁胺输注方案的重度肥胖合并症患者中的可行性、安全性和实用性，这些患者因减肥手术接受评估，以检测心肌缺血的存在。
招募患有已知或疑似CAD且因减肥手术接受评估的重度肥胖[体重指数（BMI）>40 kg/m²]患者。
20名受试者（9名男性/11名女性），年龄50±8岁（均值±标准差），体重141±21 kg，BMI为50±5 kg/m²，纳入本研究并接受TE-DSE检查。所采用的加速多巴酚丁胺输注方案耐受性良好。18名（90%）受试者达到目标心率，平均插管时间为13±4分钟。多巴酚丁胺平均剂量为31.5±9.9 μg/kg/min，而阿托品平均剂量为0.5±0.3 mg。所有受试者对TE-DSE耐受性良好，无并发症，包括无明显心律失常、低血压或动脉血氧饱和度降低。两名受试者TE-DSE异常，提示心肌缺血。所有患者均接受了减肥手术，无心血管并发症记录。
采用加速输注方案的TE-DSE是一种安全且耐受性良好的成像技术，可用于评估等待减肥手术的重度肥胖患者的疑似心肌缺血和心脏手术风险。此外，TE-DSE未发现心肌缺血与心脏事件的低手术风险密切相关。
