Shah Benoy N, Senior Roxy
Department of Cardiology, Wessex Cardiac Centre, University Hospital Southampton, Southampton, UK
Department of Echocardiography, Royal Brompton Hospital, London, UK National Heart & Lung Institute, Imperial College London, London, UK.
Echo Res Pract. 2016 Jun;3(2):R13-8. doi: 10.1530/ERP-16-0010. Epub 2016 Apr 7.
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.
全球范围内，严重肥胖的发病率正在上升。这些患者常常伴有多种心血管危险因素，因此经常被转诊去做无创心脏成像检查。负荷超声心动图（SE）被广泛用于评估已知或疑似冠心病（CAD）的患者，但其在病态肥胖患者（这类患者的图像质量可能因体型而受影响）中的临床实用性在很大程度上尚不清楚。最近发表的《病态肥胖中的负荷超声检查（SUMO）》研究表明，当适当地使用超声造影剂进行SE检查时（无论是采用生理性还是药物性负荷），具有极佳的可行性，并且能够对病态肥胖患者进行合理的风险分层，包括识别需要血运重建的患者。本文回顾了支持在病态肥胖患者中使用超声心动图技术评估已知或疑似CAD的证据，并简要讨论了其他无创检查方法，包括磁共振和核技术，同时将这些技术与SE进行比较和对比。
