terça-feira, maio 03, 2011
Ecostress e obesidade
Negative Stress Echocardiography in Severely Obese Patients has Good Prognostic Value: P1-09
Murphy, Michele A.
Medical College of Georgia, Augusta, GA
Background: The evaluation of severely obese patients with chest pain is very challenging with any noninvasive testing modality, and there is limited evidence to guide clinical evaluation of these patients. We sought to evaluate the prognostic value of normal stress echocardiography (SE) in obese patients. Methods: Chart review of consecutive 1446 patients undergoing SE was performed. Medical records were reviewed and telephone contact was made to determine Major Adverse Cardiac Events (MACE: Myocardial infarction and cardiac death), subsequent hospitalization for cardiac events and cardiac intervention and ER visits at 1 year. After excluding patients with a BMI of 25-29.9 kg/m2, abnormal SE, and those who were lost to follow-up, a retrospective analysis of 508 patients was performed. There were 366 obese patients (BMI >= 30) and 142 patients with normal BMI (18.5-24.9 kg/m2). Baseline characteristics and MACE were compared between two groups using [chi]2, and Fisher's exact test. Results: Obese patients had a mean BMI of 37.3 ±0.3 vs. 22.6±0.13 kg/m2 in normal. Age in normal patients was 53.2±1.2 years vs. 50.3±0.6 in obese. There were more whites (p= 0.0093) in the normal group and more blacks (p= 0.0095) in the obese group. More patients had hypertension (p=0.0199) and diabetes (p =0.0001) in the obese group. Obese patients also had more complaints of chest pain (p=0.0165) during initial evaluation. Definity was used more often in obese patients (p=0.0058). There were no MACE observed in the obese or the normal weight group at 1 year follow-up after a normal SE. Patients lost to follow up had similar numbers of obese and non obese subjects and similar clinical characteristics as the overall group mentioned above. Conclusions: In this large cohort of patients, normal SE has a good prognostic value at one year, even in severely obese patients with multiple cardiac risk factors including diabetes and hypertension. SE is an effective and reliable noninvasive tool in the evaluation of obese patients with chest pain.
Tendência muito observada na prática diária, janela acústica dificilmente atrapalha o exame de ecostress, principalmente com esforço, quando a janela tende a melhorar com o aumento do espaço intercostal durante o exame...