Exercise-induced Wall Motion Abnormalities and Resting Left Ventricular Dysfunction in the Morbidly Obese as Assessed by Radionuclide Ventriculography |
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Authors: | Gary L Murray MD FACC George S M Cowan Jr MD Roger Vander-Zwagg PhD |
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Institution: | (1) Departments of Surgery, Cardiology, Baptist Memorial Hospital, Memphis, TN, USA;(2) Department of Surgery, University of Tennessee School of Medicine, Memphis, TN, USA;(3) Department of Health Services Research, Baptist Memorial Hospital, Memphis, TN, USA |
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Abstract: | Rest and exercise first pass radionuclide ventriculograms were obtained in 62 morbidly obese subjects (56 women, six men,
mean age 38 years, mean weight 269.2 ± 46.0 lb, mean height 65.2 ± 3.1 in., mean Body Mass Index 44.5 ± 6.2 kg/m2, mean excess body weight 134.1 ± 41.1 lb) scheduled for vertical banded gastroplasty. Fifty-six percent demonstrated exercise-induced
wall motion abnormalities mimicking coronary disease, compared to 12% of controls (p = 0.03). No subject with exercise-induced abnormalities had coronary disease at cardiac catheterization although only those
with an anginal chest pain history underwent angiography. Twenty-six percent demonstrated resting left ventricular systolic
dysfunction as manifested by a reduced resting left ventricular ejection fraction (<0.50). Thirty-one percent of these patients
demonstrated exercise-induced abnormalities, versus 65% of morbidly obese subjects with normal resting ejection fractions
(p = 0.04). Obesity-induced left ventricular hypertrophy with associated reduced coronary vasodilator reserve could explain
the abnormalities. Six month post-gastroplasty follow-up radionuclide ventriculograms show group normalization of the resting
left ventricular ejection fraction in those with preoperative dysfunction, possibly due to left ventricular unloading with
some regression of hypertrophy. |
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Keywords: | Cardiac angiography cardiac dysfunction cardiac hypertrophy cardiomyopathy echocardiography ergometry gastroplasty morbid obesity radionuclide ventriculography |
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