title: Transesophageal dobutamine stress echocardiography in the evaluation of myocardial ischemia in morbidly obese subjects.
abstract: BACKGROUND
  The evaluation of chest pain or suspected coronary artery disease (CAD) in morbidly obese subjects is limited by the inability of routine diagnostic techniques to adequately image these individuals. Morbidly obese subjects are therefore often inadequately treated or inappropriately treated for presumed CAD.
  
  
  RESULTS
  We prospectively evaluated 23 morbidly obese patients with chest pain using transesophageal dobutamine stress echocardiography (TE-DSE). The mean (+/- SD) weight was 164 +/- 8 kg (range, 118 to 215 kg). We identified nine patients with abnormal TE-DSE findings. Five of these patients subsequently had cardiac catheterization with confirmation of CAD in the regions identified by TE-DSE. Over a follow-up period of 18 +/- 6 months, three cardiac events (non-Q-wave myocardial infarction) occurred in the same group, including two patients without confirmatory cardiac catheterization data. Thus, seven of nine patients with positive results of TE-DSE had objective confirmatory evidence of CAD. No cardiac events were observed in the group with normal TE-DSE over the same follow-up period.
  
  
  CONCLUSIONS
  TE-DSE is a safe and potentially useful technique for the evaluation of suspected CAD in morbidly obese subjects.
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN 37232-6300, USA.
authors.forename: E C
authors.initials: EC
authors.lastname: Madu
mesh_terms: D000328:Adult; D002316:Cardiotonic Agents; D002637:Chest Pain / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003937:Diagnosis, Differential; D004280:Dobutamine; D017548:Echocardiography, Transesophageal / Q000187:drug effects; D005080:Exercise Test / Q000187:drug effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology; D009767:Obesity, Morbid / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine