Transesophageal dobutamine stress echocardiography in the evaluation of myocardial ischemia in morbidly obese subjects

Background: The evaluation of chest pain or suspected coronary artery disea se (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 treat ed for presumed CAD. Methods and results: We prospectively evaluated 23 morbidly obese patients with chest pain using transesophageal dobutamine stress echocardiography (T E-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 pati ents subsequently had cardiac catheterization with confirmation of CAD in t he 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 s ame group, including two patients without confirmatory cardiac catheterizat ion 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 evalu ation of suspected CAD in morbidly obese subjects.