Supariwala Azhar, Makani Harikrishna, Kahan Jonathan, Pierce Matthew, Bajwa Farhan, Dukkipati Sai Sreenija, Teixeira Julio, Chaudhry Farooq A
Division of Cardiology, Department of Medicine, St Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York.
Echocardiography. 2014 Aug;31(7):879-85. doi: 10.1111/echo.12481. Epub 2013 Dec 17.
Stress echocardiography (SE) is clinically used in the risk stratification and prognosis of patients with coronary artery disease. Due to multiple comorbidities, obese patients have increased risk of adverse cardiovascular events perioperatively in noncardiac surgery. The aim of this study was to investigate the feasibility of SE in morbidly obese patients undergoing bariatric surgery.
Consecutive patients referred for SE for preoperative evaluation prior to bariatric surgery from January 2002 to July 2011 formed the study cohort. Contrast was used to define the endocardial border in patients with poor acoustic windows. All-cause mortality data were obtained from Social Security Death Index.
Six hundred fifty-two patients (47 ± 10 years, 84% females) with the mean follow-up of 3.0 ± 2.7 years and mean body mass index (BMI) of 47 ± 9 kg/m² were included in this analysis. Dobutamine SE was performed in 65% of patients compared to exercise SE in 35%. Patients with higher BMI were more likely to undergo dobutamine SE (P < 0.0001). Similarly, incidence of poor acoustic windows and contrast use was higher in those with increased BMI (P < 0.001). Contrast use was higher in patients undergoing dobutamine SE (39%) versus exercise (25%), (P = 0.002). 19 patients (3%) had an abnormal SE and 8 patients (1.2%) died during the follow-up period.
Stress echocardiography is feasible in the morbidly obese patients. Patients with higher BMI were more likely to undergo dobutamine SE and have higher incidence of poor acoustic windows and contrast use.
负荷超声心动图（SE）在冠心病患者的风险分层和预后评估中具有临床应用价值。由于存在多种合并症，肥胖患者在非心脏手术围手术期发生不良心血管事件的风险增加。本研究旨在探讨SE在接受减重手术的病态肥胖患者中的可行性。
选取2002年1月至2011年7月因减重手术前评估而接受SE检查的连续患者组成研究队列。对于声窗不佳的患者，使用造影剂来确定心内膜边界。全因死亡率数据来自社会保障死亡指数。
本分析纳入了652例患者（年龄47±10岁，84%为女性），平均随访3.0±2.7年，平均体重指数（BMI）为47±9kg/m²。65%的患者接受了多巴酚丁胺SE检查，35%的患者接受了运动SE检查。BMI较高的患者更有可能接受多巴酚丁胺SE检查（P<0.0001）。同样，BMI增加的患者声窗不佳和使用造影剂的发生率更高（P<0.001）。接受多巴酚丁胺SE检查的患者使用造影剂的比例（39%）高于运动SE检查的患者（25%），（P=0.002）。19例患者（3%）SE检查结果异常，8例患者（1.2%）在随访期间死亡。
负荷超声心动图在病态肥胖患者中是可行的。BMI较高的患者更有可能接受多巴酚丁胺SE检查，且声窗不佳和使用造影剂的发生率更高。
