EVALUATION OF CORONARY ARTERY DISEASE IN OBESE PATIENTS. THE ROLE OF NON-INVASIVE CARDIAC IMAGING



Abdou Elhendy, M.D., Ph.D., Marshfield, WI, USA

The risk of coronary artery disease (CAD) and subsequent morbidity is increased in obese patients. Furthermore, obesity may mimic or mask manifestation of cardiovascular disease. Evaluation of CAD in obese patients is difficult due to limited value of history and clinical examination, the presence of EKG abnormalities, sleep apnea, left ventricular hypertrophy, poor exercise tolerance and imaging artifacts. Cardiovascular imaging is a vital modality to assess risk in these patients. Available modalities include transthoracic and transesophageal stress echocardiography, myocardial perfusion imaging including PET, Dobutamine MRI and CT angiography. Echocardiography is widely available and does not have weight or torso table limitation of other techniques. PET and MRI imaging provide excellent imaging quality. Increased frequency of artifacts may lead to decreased specificity, repeat testing and unneeded catheterizations. A careful understanding of the advantages and limitations of each imaging technique allows for better resource allocation. More prospective studies are needed to define the merits of these imaging modalities in obese patients.