Background: The evaluation of chest pain or suspected
coronary artery disease (CAD) in morbidly obese subjects is limited by
the inability of routine diagnostic techniques to adequately image
these individuals. Morbidly obese subjects are therefore often
inadequately treated or inappropriately treated for presumed CAD.
Methods and results: We prospectively evaluated 23 morbidly
obese patients with chest pain using transesophageal dobutamine stress
echocardiography (TE-DSE). The mean (± SD) weight was
164 ± 8 kg (range, 118 to 215 kg). We identified nine
patients with abnormal TE-DSE findings. Five of these patients
subsequently had cardiac catheterization with confirmation of CAD in
the regions identified by TE-DSE. Over a follow-up period of 18 ± 6
months, three cardiac events (non-Q-wave myocardial infarction)
occurred in the same group, including two patients without confirmatory
cardiac catheterization data. Thus, seven of nine patients with
positive results of TE-DSE had objective confirmatory evidence of CAD.
No cardiac events were observed in the group with normal TE-DSE over
the same follow-up period.
Conclusion: TE-DSE is a
safe and potentially useful technique for the evaluation of suspected
CAD in morbidly obese subjects.