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COMPARATIVE FEASIBILITY OF DOBUTAMINE STRESS ECHOCARDIOGRAPHY PERFORMED WITH AND WITHOUT INTRAVENOUS CONTRAST IN PATIENTS WITH CLASS III OBESITY
  • +2
  • Carl Carlino,
  • Saravanan Kuppuswamy,
  • Lerin McCray,
  • Kul Aggarwal,
  • Martin Alpert
Carl Carlino
University of Missouri School of Medicine
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Saravanan Kuppuswamy
University of Missouri School of Medicine
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Lerin McCray
University of Missouri School of Medicine
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Kul Aggarwal
University of Missouri School of Medicine
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Martin Alpert
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Abstract

Background: Concern exists regarding adequacy of visualization of stress echocardiograms performed without intravenous contrast in persons with Class III obesity (body mass index ≥ 40 kg/m2). Methods: Dobutamine stress echocardiography (DSE) was performed on 128 candidates for bariatric surgery with class III obesity without chest pain or pre-existent coronary artery disease (CAD). DSE without intravenous contrast was initially performed on 62 patients with class III obesity, then was subsequently was performed with intravenous contrast on 66 patients with class III obesity. Left ventricular (LV) regional wall motion was assessed at baseline and peak stress using the 16-segment model. Results: In the intravenous contrast group 1046 of 1056 LV segments studied (99.1%) were well-visualized and interpretable at baseline and 1044 of 1056 LV segments studied (98.9%) were well-visualized and interpretable at peak stress. In the non-contrast group 905 of 992 segments studied (91.2%) were well-visualized and interpretable at baseline and 886 of 992 segments studied (89.3%) were well-visualized and interpretable at peak stress. A significantly greater number of LV segments were well-visualized and interpretable in the intravenous contrast group than in the group compared to the non-contrast group, at baseline and at peak stress (p < 0.00001 for both). DSE was positive for ischemia in 1 patient. All patients underwent bariatric surgery without cardiovascular complications. Six months after surgery, all patients were alive; none developed cardiovascular events. Conclusion: The use of intravenous contrast during DSE significantly improves visualization and interpretability of LV segments in patients with class III obesity.

Peer review status:ACCEPTED

13 Jun 2021Submitted to Echocardiography
14 Jun 2021Submission Checks Completed
14 Jun 2021Assigned to Editor
02 Jul 2021Reviewer(s) Assigned
26 Jul 2021Review(s) Completed, Editorial Evaluation Pending
29 Jul 2021Editorial Decision: Revise Minor
10 Aug 20211st Revision Received
11 Aug 2021Submission Checks Completed
11 Aug 2021Assigned to Editor
14 Aug 2021Reviewer(s) Assigned
22 Aug 2021Review(s) Completed, Editorial Evaluation Pending
30 Aug 2021Editorial Decision: Accept