Avaliação da isquemia miocárdica em obesos submetidos à ecocardiografia sob estresse físico

Abstract

Background: Physical stress echocardiography (PSE) is an established methodology for diagnosis and risk stratification of coronary artery disease (CAD) in patients with physical capacity . The use of FES in detecting ischemia in obese ( BMI ≥ 30 kg/m2 ) , has been demonstrated to pharmacological stress echocardiography , however, has not been reported in the PSE . Objective: To evaluate the presence of myocardial ischemia in the obese PSE. Methods : We studied 4050 patients on a treadmill , divided into two groups : obese (23.3 %) and non-obese (76.6 %) .We compared clinical and echocardiographic characteristics . Results: obese patients had a mean age of 55.4 ± 10.9 years , of whom 52.1 % were female . Differences between groups in clinical characteristics : high blood pressure (HBP ) ( 75.2 % vs 57.2 %, p < 0.0001 ) , diabetes mellitus ( DM ) ( 15.2 % vs 10.9 %, p < 0.0001), dyslipidemia ( 59.5 % vs 51.9 %, p < 0.0001 ) and family history ( 59.3 % vs 55.1 %, p < 0.001), physical inactivity ( 71.4 % vs 52 9% , p < 0.0001). Dimensions of cardiac chambers : the aorta ( 3.27 vs 3.14, p < 0.0001), left atrium (LA ) ( 3.97 vs 3.72 , p < 0.0001 ) , LA volume ( 26.3 vs. 22.6, p < 0.0001), relative thickness of the left ventricle ( LV) ( 33.7 vs. 32.8 , p < 0.0001), LV ejection fraction ( 0.66 vs 0.70 ; p = 0.53 ) .14 . Of all patients analyzed , 19.8 % had undergone catheterization and 14.7 % had positive catheterization for myocardial ischemia . Obese showed myocardial ischemia in 19 % and not 17.9% obese ( p = .41 ) . In adjusted logistic regression analysis, myocardial ischemia remained independently associated with age, female gender, diabetes and hypertension . Conclusion: age, hypertension, dyslipidemia, diabetes mellitus and female gender were the main predictors of myocardial ischemia in obese patients undergoing EPS. Obesity alone is not outcome factor for CAD diagnosis of FES.