title: Feasibility and prognostic value of stress echocardiography in obese, morbidly obese, and super obese patients referred for bariatric surgery.
abstract: BACKGROUND
  Stress echocardiography (SE) is clinically used in the risk stratification and prognosis of patients with coronary artery disease. Due to multiple comorbidities, obese patients have increased risk of adverse cardiovascular events perioperatively in noncardiac surgery. The aim of this study was to investigate the feasibility of SE in morbidly obese patients undergoing bariatric surgery.
  
  
  METHODS
  Consecutive patients referred for SE for preoperative evaluation prior to bariatric surgery from January 2002 to July 2011 formed the study cohort. Contrast was used to define the endocardial border in patients with poor acoustic windows. All-cause mortality data were obtained from Social Security Death Index.
  
  
  RESULTS
  Six hundred fifty-two patients (47 ± 10 years, 84% females) with the mean follow-up of 3.0 ± 2.7 years and mean body mass index (BMI) of 47 ± 9 kg/m² were included in this analysis. Dobutamine SE was performed in 65% of patients compared to exercise SE in 35%. Patients with higher BMI were more likely to undergo dobutamine SE (P < 0.0001). Similarly, incidence of poor acoustic windows and contrast use was higher in those with increased BMI (P < 0.001). Contrast use was higher in patients undergoing dobutamine SE (39%) versus exercise (25%), (P = 0.002). 19 patients (3%) had an abnormal SE and 8 patients (1.2%) died during the follow-up period.
  
  
  CONCLUSIONS
  Stress echocardiography is feasible in the morbidly obese patients. Patients with higher BMI were more likely to undergo dobutamine SE and have higher incidence of poor acoustic windows and contrast use.
authors.affiliation: Division of Cardiology, Department of Medicine, St Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Azhar
authors.initials: A
authors.lastname: Supariwala
authors.forename: Harikrishna
authors.initials: H
authors.lastname: Makani
authors.forename: Jonathan
authors.initials: J
authors.lastname: Kahan
authors.forename: Matthew
authors.initials: M
authors.lastname: Pierce
authors.forename: Farhan
authors.initials: F
authors.lastname: Bajwa
authors.forename: Sai Sreenija
authors.initials: SS
authors.lastname: Dukkipati
authors.forename: Julio
authors.initials: J
authors.lastname: Teixeira
authors.forename: Farooq A
authors.initials: FA
authors.lastname: Chaudhry
mesh_terms: D000328:Adult; D000418:Albumins; D000704:Analysis of Variance; D050110:Bariatric Surgery / Q000379:methods*; D015992:Body Mass Index; D015331:Cohort Studies; D003287:Contrast Media; D003327:Coronary Disease / Q000150:complications / Q000000981:diagnostic imaging*; D025401:Echocardiography, Stress / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005466:Fluorocarbons; D005500:Follow-Up Studies; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D009767:Obesity, Morbid / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D000418:Albumins; D003287:Contrast Media; C099458:FS 069; D005466:Fluorocarbons; C042852:perflutren
keywords: bariatric surgery; morbidly obese; obesity; prognosis; stress echocardiography