Department of Internal Medicine, Botucatu Medical School, São Paulo State University, UNESP, Botucatu, SP, Brazil.
Med Sci Monit. 2022 Jul 30;28:e937362. doi: 10.12659/MSM.937362.
Body weight has increased worldwide, characterizing a pandemic of overweight and obesity. Obesity is associated with several risk factors for cardiovascular disease. However, the association between increased body weight and cardiovascular disease is independent of the presence of classical cardiovascular disease risk factors. The direct effects of excessive fat tissue on the heart can cause a specific obesity-related cardiomyopathy in the absence of hypertension, coronary heart disease, and other structural heart diseases. Hemodynamic and structural changes contribute to obesity cardiomyopathy. The changes culminate in diastolic dysfunction, and eventually systolic dysfunction and heart failure. Several cellular cardiac changes have been described in obesity. Patients with obesity often present symptoms such as dyspnea, fatigue, lower limb edema, and chest pain. Noninvasive imaging techniques are important in assessing cardiovascular risk and evaluating symptoms. However, excess adiposity may be challenging for cardiac imaging interpretation and diagnostic accuracy. This review aims to discuss the current roles and limitations of noninvasive imaging diagnostic methods for investigating cardiovascular disease in individuals with obesity. The methods discussed include electrocardiography, echocardiography, 2-dimensional speckle tracking echocardiography, real-time 3-dimensional echocardiography, transesophageal echocardiography, computed tomography and coronary computed tomography angiography, cardiovascular magnetic resonance, stress tests ergometry, stress echocardiography, transesophageal echocardiography with pharmacological stress, stress computed tomography, stress cardiac magnetic resonance, single-photon emission computerized tomography myocardial perfusion imaging, and positron emission tomography. Although the appropriate choice of tests depends on the knowledge of methods and their limitations, patient management should be tailored according to clinical evaluation and technique availability.
全球体重增加，超重和肥胖成为一种流行疾病。肥胖与心血管疾病的几个危险因素有关。然而，体重增加与心血管疾病的关联独立于存在经典的心血管疾病危险因素。过多脂肪组织对心脏的直接影响可导致在无高血压、冠心病和其他结构性心脏病的情况下出现特定的肥胖相关性心肌病。血流动力学和结构变化促成肥胖性心肌病。这些变化最终导致舒张功能障碍，进而导致收缩功能障碍和心力衰竭。在肥胖中已经描述了几种细胞心脏变化。肥胖患者常出现呼吸困难、疲劳、下肢水肿和胸痛等症状。非侵入性成像技术对于评估心血管风险和评估症状非常重要。然而，过多的肥胖可能会对心脏成像解释和诊断准确性造成挑战。本综述旨在讨论用于研究肥胖个体心血管疾病的非侵入性成像诊断方法的当前作用和局限性。讨论的方法包括心电图、超声心动图、二维斑点追踪超声心动图、实时三维超声心动图、经食管超声心动图、计算机断层扫描和冠状动脉计算机断层血管造影、心血管磁共振、运动试验、应激超声心动图、经食管超声心动图药物负荷试验、应激计算机断层扫描、应激心脏磁共振、单光子发射计算机化断层扫描心肌灌注成像和正电子发射断层扫描。虽然适当的测试选择取决于对方法及其局限性的了解，但患者管理应根据临床评估和技术可用性进行调整。
