Abstract 14281: Comparative Visualization of Left Ventricular Segments With and Without Intravenous Contrast During Dobutamine Stress Echocardiography in Class III Obese Patients

Abstract

Introduction: Concern exists regarding adequacy of visualization of stress echocardiograms performed without intravenous contrast (IVC) enhancement in patients with Class III obesity (body mass index ≥ 40 kg/m 2 ). Hypothesis: Use of (IVC) enhancement will significantly improve visualization and interpretability for ischemia of left ventricular (LV) segments during dobutamine stress echocardiography (DSE) at baseline and at peak stress compared to non-use of IVC enhancement. Methods: DSE was performed on 128 candidates for bariatric surgery with class III obesity without chest pain or pre-existent coronary artery disease. DSE without IVC was initially performed on 62 patients with class III obesity, then was subsequently was performed with IVC on 66 patients with class III obesity. LV regional wall motion was assessed at baseline and peak stress using the 16-segment model. Results: In the IVC group 1046 of 1056 LV segments studied (99.1%) were well-visualized and interpretable at baseline and 1044 of 1056 LV segments studied (98.9%) were well-visualized and interpretable at peak stress. In the non-IVC group 905 of 992 LV segments studied (91.2%) were well-visualized and interpretable at baseline and 886 of 992 LV segments studied (89.3%) were well-visualized and interpretable at peak stress. A significantly greater number of LV segments were well-visualized and interpretable in the IVC group compared to the non-contrast group, at baseline and at peak stress (p < 0.00001 for both). DSE was positive for ischemia in 1 patient. All patients eventually underwent bariatric surgery without cardiovascular complications. Six months after surgery, all patients were alive; none developed cardiovascular events. Conclusion: The use of IVC enhancement during DSE significantly improves visualization and interpretability of lLV segments in patients with class III obesity and relatively low cardiovascular risk.