Effect of Pharmacologic Stress Test Results on Outcomes in Obese versus Nonobese Subjects Referred for Stress Perfusion Echocardiography

Nicola Gaibazzi, Valentina Lorenzoni, Claudio Reverberi, Juefei Wu, Feng Xie, Thomas Richard Porter

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Real-time contrast stress echocardiography (RTCSE) permits the simultaneous analysis of myocardial perfusion and wall motion during stress echocardiography, which has resulted in improved coronary artery disease detection. Although several studies have confirmed a protective effect of obesity in coronary artery disease, it is unclear whether this benefit is dependent on the functional significance of the disease. The objective of this study was to compare outcomes in obese versus nonobese subjects referred for pharmacologic RTCSE. Methods: A retrospective comparison of wall motion and myocardial perfusion with RTCSE was assessed in 481 obese and 961 nonobese patients matched for age and gender without known coronary artery disease referred for either dobutamine (n = 1,056) or dipyridamole (n = 386) stress echocardiography at two separate institutions. Outcomes (death or nonfatal infarction) were determined over a median follow-up period of 1,195 days. Results: Abnormal myocardial perfusion and/or wall motion was seen in 207 (20%) dobutamine and 61 (16%) dipyridamole studies. Abnormal rates were similar in obese (17%) and nonobese (19%) subjects. Event-free survival was significantly worse only for nonobese subjects referred for dobutamine RTCSE, with obesity (not test result) being an independent predictor of event-free survival on multivariate analysis (P = .001). No protective effect of obesity was observed following dipyridamole RTCSE. Conclusions: Obese subjects in the United States referred for demand stress testing have better outcomes when directly compared with age- and gender-matched nonobese subjects with similar degrees of inducible ischemia.

Original languageEnglish (US)
JournalJournal of the American Society of Echocardiography
DOIs
StateAccepted/In press - 2016

Fingerprint

Stress Echocardiography
Exercise Test
Perfusion
Echocardiography
Dobutamine
Dipyridamole
Coronary Artery Disease
Obesity
Disease-Free Survival
Infarction
Multivariate Analysis
Ischemia

Keywords

  • Obese
  • Outcome
  • Perfusion
  • Stress echocardiography
  • Wall motion

ASJC Scopus subject areas

  • Medicine(all)
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{a529d352163c402ab13f2d737607162b,
title = "Effect of Pharmacologic Stress Test Results on Outcomes in Obese versus Nonobese Subjects Referred for Stress Perfusion Echocardiography",
abstract = "Background: Real-time contrast stress echocardiography (RTCSE) permits the simultaneous analysis of myocardial perfusion and wall motion during stress echocardiography, which has resulted in improved coronary artery disease detection. Although several studies have confirmed a protective effect of obesity in coronary artery disease, it is unclear whether this benefit is dependent on the functional significance of the disease. The objective of this study was to compare outcomes in obese versus nonobese subjects referred for pharmacologic RTCSE. Methods: A retrospective comparison of wall motion and myocardial perfusion with RTCSE was assessed in 481 obese and 961 nonobese patients matched for age and gender without known coronary artery disease referred for either dobutamine (n = 1,056) or dipyridamole (n = 386) stress echocardiography at two separate institutions. Outcomes (death or nonfatal infarction) were determined over a median follow-up period of 1,195 days. Results: Abnormal myocardial perfusion and/or wall motion was seen in 207 (20{\%}) dobutamine and 61 (16{\%}) dipyridamole studies. Abnormal rates were similar in obese (17{\%}) and nonobese (19{\%}) subjects. Event-free survival was significantly worse only for nonobese subjects referred for dobutamine RTCSE, with obesity (not test result) being an independent predictor of event-free survival on multivariate analysis (P = .001). No protective effect of obesity was observed following dipyridamole RTCSE. Conclusions: Obese subjects in the United States referred for demand stress testing have better outcomes when directly compared with age- and gender-matched nonobese subjects with similar degrees of inducible ischemia.",
keywords = "Obese, Outcome, Perfusion, Stress echocardiography, Wall motion",
author = "Nicola Gaibazzi and Valentina Lorenzoni and Claudio Reverberi and Juefei Wu and Feng Xie and Porter, {Thomas Richard}",
year = "2016",
doi = "10.1016/j.echo.2016.06.002",
language = "English (US)",
journal = "Journal of the American Society of Echocardiography",
issn = "0894-7317",
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T1 - Effect of Pharmacologic Stress Test Results on Outcomes in Obese versus Nonobese Subjects Referred for Stress Perfusion Echocardiography

AU - Gaibazzi, Nicola

AU - Lorenzoni, Valentina

AU - Reverberi, Claudio

AU - Wu, Juefei

AU - Xie, Feng

AU - Porter, Thomas Richard

PY - 2016

Y1 - 2016

N2 - Background: Real-time contrast stress echocardiography (RTCSE) permits the simultaneous analysis of myocardial perfusion and wall motion during stress echocardiography, which has resulted in improved coronary artery disease detection. Although several studies have confirmed a protective effect of obesity in coronary artery disease, it is unclear whether this benefit is dependent on the functional significance of the disease. The objective of this study was to compare outcomes in obese versus nonobese subjects referred for pharmacologic RTCSE. Methods: A retrospective comparison of wall motion and myocardial perfusion with RTCSE was assessed in 481 obese and 961 nonobese patients matched for age and gender without known coronary artery disease referred for either dobutamine (n = 1,056) or dipyridamole (n = 386) stress echocardiography at two separate institutions. Outcomes (death or nonfatal infarction) were determined over a median follow-up period of 1,195 days. Results: Abnormal myocardial perfusion and/or wall motion was seen in 207 (20%) dobutamine and 61 (16%) dipyridamole studies. Abnormal rates were similar in obese (17%) and nonobese (19%) subjects. Event-free survival was significantly worse only for nonobese subjects referred for dobutamine RTCSE, with obesity (not test result) being an independent predictor of event-free survival on multivariate analysis (P = .001). No protective effect of obesity was observed following dipyridamole RTCSE. Conclusions: Obese subjects in the United States referred for demand stress testing have better outcomes when directly compared with age- and gender-matched nonobese subjects with similar degrees of inducible ischemia.

AB - Background: Real-time contrast stress echocardiography (RTCSE) permits the simultaneous analysis of myocardial perfusion and wall motion during stress echocardiography, which has resulted in improved coronary artery disease detection. Although several studies have confirmed a protective effect of obesity in coronary artery disease, it is unclear whether this benefit is dependent on the functional significance of the disease. The objective of this study was to compare outcomes in obese versus nonobese subjects referred for pharmacologic RTCSE. Methods: A retrospective comparison of wall motion and myocardial perfusion with RTCSE was assessed in 481 obese and 961 nonobese patients matched for age and gender without known coronary artery disease referred for either dobutamine (n = 1,056) or dipyridamole (n = 386) stress echocardiography at two separate institutions. Outcomes (death or nonfatal infarction) were determined over a median follow-up period of 1,195 days. Results: Abnormal myocardial perfusion and/or wall motion was seen in 207 (20%) dobutamine and 61 (16%) dipyridamole studies. Abnormal rates were similar in obese (17%) and nonobese (19%) subjects. Event-free survival was significantly worse only for nonobese subjects referred for dobutamine RTCSE, with obesity (not test result) being an independent predictor of event-free survival on multivariate analysis (P = .001). No protective effect of obesity was observed following dipyridamole RTCSE. Conclusions: Obese subjects in the United States referred for demand stress testing have better outcomes when directly compared with age- and gender-matched nonobese subjects with similar degrees of inducible ischemia.

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KW - Outcome

KW - Perfusion

KW - Stress echocardiography

KW - Wall motion

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