INTRODUCTION
Obesity, particularly central obesity is commonly associated with a
variety of traditional and non-traditional cardiovascular (CV) risk
factors and is a key component of the metabolic syndrome which itself is
a potent risk factor for cardiovascular disease
(CVD).1-3 Accordingly, obesity is considered to be a
risk factor for CVD.1-3 Moreover, the
27th Bethesda Conference classified obesity as an
independent risk factor for CVD.2 For these reasons
testing for CVD, particularly coronary artery disease (CAD) is performed
frequently in both symptomatic and asymptomatic patients with obesity,
often in preparation for elective non-cardiac
surgery.4 In patients with mildly-to-moderate obesity,
standard methods of stress testing can be performed with an acceptable
sensitivity, specificity, and predictive accuracy.5-9In patients with extreme (Class III) obesity there are limitations
associated with standard stress testing modalities.5-9Poor functional capacity may limit the effectiveness of stress tests
that employ treadmill exercise.3,5,7–9 Excessive
attenuation and weight restrictions may interfere with the ability to
obtain accurate pharmacologic myocardial perfusion
scans.7,9 Weight and size limitations and cost
considerations cause stress cardiac magnetic resonance imaging to be
used infrequently in patients with class III obesity.7Dobutamine stress echocardiography (DSE) is the most commonly-used
stress testing modality in such patients.5,7,9,10However, concern exists about the ability to adequately image left
ventricular (LV) segments without the use of intravenous contrast. The
purpose of this prospective non-randomized study was to compare
feasibility of DSE with and without intravenous contrast in patients
with class III obesity without chest pain or pre-existent CAD who were
candidates for and eventually underwent bariatric surgery
Alpert