title: Transthoracic dobutamine stress echocardiography in patients undergoing bariatric surgery.
abstract: BACKGROUND
  The feasibility and value of transthoracic dobutamine stress echocardiography (DSE) in patients scheduled for bariatric surgery has not been investigated.
  
  
  METHODS
  We evaluated 611 patients (86.6% female, 42 +/- 10 years, 136 +/- 18 kg, BMI 48.0 +/- 6.1 kg/m2) referred for DSE prior to surgery between February 2000 and July 2005. Mortality and major cardiovascular events (cardiac death, acute coronary syndrome, and urgent revascularization) were recorded 30-days postoperatively and at 6 months.
  
  
  RESULTS
  Adequate baseline imaging quality was achieved in 590 patients (96.6%), with use of echocardiographic contrast agents in 426 patients (72.2%); the remaining 21 patients (3.4%) were referred for alternative preoperative testing. There were no serious adverse events during DSE, which was negative in 545 patients (92.4%). The test was inconclusive in 38 patients (6.4%), requiring alternative investigations, and positive in 7 patients (1.2%). Eventually, 595 patients proceeded to surgery: 539 with DSE-based risk stratification and 56 with risk stratification based on alternative testing. Laparoscopic procedures were employed in 77.0% of patients. There were 3 perioperative deaths, all attributed to sepsis (perioperative mortality 0.50%), but no major cardiovascular events at 30-days. One patient (evaluated prior to surgery with alternative testing) experienced an acute coronary syndrome during the following 6 months (event rate 0.17%).
  
  
  CONCLUSIONS
  Transthoracic DSE is feasible and safe in morbidly obese patients undergoing bariatric surgery; implementation of echocardiographic contrast agents allows for adequate imaging quality in the majority of these patients. However, the very low risk of contemporary bariatric procedures questions the need for routine preoperative stress testing in asymptomatic patients.
authors.affiliation: Division of Cardiology and Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA. Stam.Lerakis@emoryhealthcare.org
authors.forename: Stamatios
authors.initials: S
authors.lastname: Lerakis
authors.forename: Andreas P
authors.initials: AP
authors.lastname: Kalogeropoulos
authors.forename: Mikhael F
authors.initials: MF
authors.lastname: El-Chami
authors.forename: Vasiliki V
authors.initials: VV
authors.lastname: Georgiopoulou
authors.forename: Arun
authors.initials: A
authors.lastname: Abraham
authors.forename: Scott A
authors.initials: SA
authors.lastname: Lynch
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Lewis
authors.forename: George C
authors.initials: GC
authors.lastname: Leach
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Osier
authors.forename: Emir
authors.initials: E
authors.lastname: Veledar
authors.forename: Randolph P
authors.initials: RP
authors.lastname: Martin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000009:adverse effects*; D015992:Body Mass Index; D025401:Echocardiography, Stress; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment