title: Assessment of Myocardial Ischemia in Obese Individuals Undergoing Physical Stress Echocardiography (PSE).
abstract: BACKGROUND
  Physical stress echocardiography is an established methodology for diagnosis and risk stratification of coronary artery disease in patients with physical capacity. In obese (body mass index ≥ 30 kg/m2) the usefulness of pharmacological stress echocardiography has been demonstrated; however, has not been reported the use of physical stress echocardiography in this growing population group.
  
  
  OBJECTIVE
  To assess the frequency of myocardial ischemia in obese and non-obese patients undergoing physical stress echocardiography and compare their clinical and echocardiographic differences.
  
  
  METHODS
  4,050 patients who underwent treadmill physical stress echocardiography were studied according to the Bruce protocol, divided into two groups: obese (n = 945; 23.3%) and non-obese (n = 3,105; 76.6%).
  
  
  RESULTS
  There was no difference regarding gender. Obese patients were younger (55.4 ± 10.9 vs. 57.56 ± 11.67) and had a higher frequency of hypertension (75.2% vs. 57, 2%; p < 0.0001), diabetis mellitus (15.2% vs. 10.9%; p < 0.0001), dyslipidemia (59.5% vs 51.9%; p < 0.0001), family history of coronary artery disease (59.3% vs. 55.1%; p = 0.023) and physical inactivity (71.4% vs. 52.9%, p < 0.0001). The obese had greater aortic dimensions (3.27 vs. 3.14 cm; p < 0.0001), left atrium (3.97 vs. 3.72 cm; p < 0.0001) and the relative thickness of the ventricule (33.7 vs. 32.8 cm; p < 0.0001). Regarding the presence of myocardial ischemia, there was no difference between groups (19% vs. 17.9%; p = 0.41). In adjusted logistic regression, the presence of myocardial ischemia remained independently associated with age, female gender, diabetes and hypertension.
  
  
  CONCLUSIONS
  Obesity did not behave as a predictor of the presence of ischemia and the physical stress echocardiography. The application of this assessment tool in large scale sample demonstrates the feasibility of the methodology, also in obese.
authors.affiliation: Departamento de Medicina, Universidade Federal de Sergipe, São Cristóvão, SE, Brazil.
authors.forename: Mara Graziele Maciel
authors.initials: MG
authors.lastname: Silveira
authors.affiliation: Departamento de Medicina, Universidade Federal de Sergipe, São Cristóvão, SE, Brazil.
authors.forename: Antônio Carlos Sobral
authors.initials: AC
authors.lastname: Sousa
authors.affiliation: Departamento de Medicina, Universidade Federal de Sergipe, São Cristóvão, SE, Brazil.
authors.forename: Marcos Antônio Almeida
authors.initials: MA
authors.lastname: Santos
authors.affiliation: Departamento de Medicina, Universidade Federal de Sergipe, São Cristóvão, SE, Brazil.
authors.forename: Irlaneide da Silva
authors.initials: Ida S
authors.lastname: Tavares
authors.affiliation: Departamento de Medicina, Universidade Federal de Sergipe, São Cristóvão, SE, Brazil.
authors.forename: Stephanie Macedo
authors.initials: SM
authors.lastname: Andrade
authors.affiliation: Departamento de Medicina, Universidade Federal de Sergipe, São Cristóvão, SE, Brazil.
authors.forename: Luiza Dantas
authors.initials: LD
authors.lastname: Melo
authors.affiliation: Departamento de Medicina, Universidade Federal de Sergipe, São Cristóvão, SE, Brazil.
authors.forename: Loren Suyane Oliveira de
authors.initials: LS
authors.lastname: Andrade
authors.affiliation: Departamento de Medicina, Universidade Federal de Sergipe, São Cristóvão, SE, Brazil.
authors.forename: Emmanuel Lima Almeida
authors.initials: EL
authors.lastname: Santos
authors.affiliation: Departamento de Medicina, Universidade Federal de Sergipe, São Cristóvão, SE, Brazil.
authors.forename: Joselina Luzia Menezes
authors.initials: JL
authors.lastname: Oliveira
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D003920:Diabetes Mellitus / Q000503:physiopathology; D025401:Echocardiography, Stress / Q000379:methods*; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology*; D009765:Obesity / Q000150:complications / Q000503:physiopathology*; D005082:Physical Exertion / Q000502:physiology*; D012016:Reference Values; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D018709:Statistics, Nonparametric