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Background: The evaluation of chest pain or suspected coronary artery disease (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 treated for presumed CAD., Methods and Results: We prospectively evaluated 23 morbidly obese patients with chest pain using transesophageal dobutamine stress echocardiography (TE-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 patients subsequently had cardiac catheterization with confirmation of CAD in the 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 same group, including two patients without confirmatory cardiac catheterization 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 evaluation of suspected CAD in morbidly obese subjects.

Dobutamine stress echocardiography has become widely accepted as a safe, reliable and cost effective modality for the evaluation of patients with suspected myocardial ischemia or for prognostic stratification and outcome assessment in patients with known coronary artery disease. while the benefits of this means of cardiovascular testing are very clearly apparent, it is important to understand and recognize possible complications. This paper discusses the occurrence of sustained, nonischemic ventricular tachycardia during dobutamine stress echocardiography in the absence of functional, physiologic or anatomic evidence of coronary artery disease or cardiomyopathy.

Exercise electrocardiography is an established mode of evaluation for patients with suspected coronary artery disease. It also provides prognostic information and guides therapeutic management in patients with established disease. However, some patients are unable to exercise because of orthopedic problems, neurologic diseases, peripheral vascular disease, or deconditioning. In the past, these patients have been referred for angiography to help assess their disease. Recently, however, new techniques to assess myocardial perfusion and/or function, including stress echocardiography, have been used in the noninvasive assessment of coronary artery disease in this group of patients. Echocardiography has been used in combination with different drugs, including dobutamine, dipyridamole, and adenosine. Dobutamine is probably the single most studied drug for stress echocardiography. Dobutamine stress echocardiography is a safe, feasible, and valuable technique for evaluating coronary artery disease.