The clinical impact of contemporary stress echocardiography in morbid obesity for the assessment of coronary artery disease

Autor: Roxy Senior, Ihab S. Ramzy, Ahmed Elghamaz, Rajdeep S. Khattar, Gothandaraman Balaji, Jatinder Pabla, Benoy N. Shah, Sothinathan Gurunathan, Konstantinos Zacharias, Nikolaos Karogiannis, Abdalla Alhajiri, Francesca Calicchio
Rok vydání: 2015
Předmět:
Male
medicine.medical_specialty
Time Factors
Myocardial Infarction
Contrast Media
Coronary Artery Disease
Kaplan-Meier Estimate
030204 cardiovascular system & hematology
Coronary Angiography
Disease-Free Survival
Angina Pectoris
Body Mass Index
Coronary artery disease
Tertiary Care Centers
03 medical and health sciences
0302 clinical medicine
Predictive Value of Tests
Risk Factors
Internal medicine
London
medicine
Stress Echocardiography
Myocardial Revascularization
Humans
030212 general & internal medicine
Myocardial infarction
Prospective Studies
Prospective cohort study
Aged
Proportional Hazards Models
Ejection fraction
Chi-Square Distribution
medicine.diagnostic_test
business.industry
Middle Aged
medicine.disease
Hospitals
District
Obesity
Morbid
Predictive value of tests
Angiography
Cardiology
Feasibility Studies
Female
Cardiology and Cardiovascular Medicine
business
Body mass index
Echocardiography
Stress
Zdroj: Heart (British Cardiac Society). 102(5)
ISSN: 1468-201X
Popis: Non-invasive cardiac imaging may suffer from poor image quality in morbidly obese individuals. This study aimed to determine the clinical value of contemporary stress echocardiography (SE) in morbidly obese patients referred for assessment of suspected coronary artery disease (CAD).This prospective, multicentre observational study was conducted in two district hospitals and one tertiary centre in London, UK. Individuals with body mass index ≥35 kg/m(2) referred for SE were evaluated. The percentage of patients with obstructive CAD on coronary angiography, following abnormal SE, was assessed. Patient outcomes were determined with follow-up for the composite end-point of all-cause mortality, myocardial infarction and late revascularisation.Over a 13-month period, 209 morbidly obese patients underwent SE, and contrast agent was used in 96% of patients. A diagnostic result was obtained in 200/209 (96%) patients. Of 32 (15%) patients with inducible ischaemia, 25 underwent angiography, 22 (88%) had corresponding significant CAD and, of these, 16 (77%) underwent revascularisation. Conversely, only 2/157 patients (1.3%) with normal SE underwent angiography, and none underwent revascularisation. Over a mean follow-up period of 17.8±5.4 months, there were nine events. The annualised cardiac event rate after a normal SE was 0.95%. Events were more frequent in patients with inducible ischaemia versus those without ischaemia (5/32 (15.6%) vs 4/153 (2.6%); p=0.002). Ejection fraction50% (HR 9.5; 95% CI 2.4 to 38.0; p=0.002) and inducible ischaemia (HR 9.4; 95% CI 2.5 to 35.8; p=0.001) were predictors of outcome on univariable Cox regression analysis.Contemporary SE has excellent feasibility and positive predictive value and resulted in appropriate risk stratification of symptomatic patients with significant obesity. A normal SE portends an excellent outcome over the short-intermediate term in this high-risk patient population.
Databáze: OpenAIRE
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