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