Safety of dobutamine stress transesophageal echocardiography in obese patients for evaluation of potential ischemic heart disease.
The purpose of this study was to determine the safety of dobutamine stress transesophageal echocardiography (DS-TEE) in the evaluation of potential coronary artery disease in obese patients. Obese patients tend to have a higher prevalence of hypertension, coronary artery disease, and sleep apnea conditions that could potentially predispose to complications during endoscopic procedures such as DS-TEE. In addition, obese patients are more likely to have oxygen desaturation during upper gastrointestinal endoscopy. Thus, the safety of DS-TEE in 90 obese patients (body mass index (BMI) > or = 27.5 kg/m2) and 86 nonobese patients (BMI < 27.5 kg/m2) was compared. Minor complications (i.e., complications of transient duration and requiring no or only simple intervention) occurred with almost equal frequency in the nonobese and obese groups (28% vs. 29%, P = ns). Transient hypotension was observed in 9% of the obese group compared to 22% in the nonobese group (P < 0.025). However, transient hypertension was noted in 20% of the obese patients compared to 6% in the nonobese group (P < 0.01). A major complication occurred in three obese patients (3.3%), which included hypotension, marked elevation of systolic blood pressure, or ventricular fibrillation. Four patients (4.7%, P = ns) of the nonobese group had a major complication, which included sustained ventricular tachycardia in one, hypertension in one, and hypotension in two patients. No deaths occurred in either group. Although obesity should remain a consideration in the risk assessment of whether or not to perform DS-TEE, when proper precautions are instituted DS-TEE appears equally safe in obese as compared to nonobese patients.
Department of Medicine, Division of Cardiology, University of Louisville, Louisville, Kentucky 40292, USA.
Tariq S
TS
Siddiqui
Marcus F
MF
Stoddard
D000368:Aged; D001794:Blood Pressure; D015992:Body Mass Index; D015897:Comorbidity; D025401:Echocardiography, Stress / Q000009:adverse effects*; D017548:Echocardiography, Transesophageal / Q000009:adverse effects*; D004869:Equipment Safety; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology*; D009765:Obesity / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology*; D010101:Oxygen Consumption; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D013318:Stroke Volume; D013599:Systole