Transesophageal Dobutamine Stress Echocardiography in the Evaluation of Myocardial Ischemia in Morbidly Obese Subjects

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.