Skip to main content
Top
Published in: Journal of Nuclear Cardiology 6/2016

01-12-2016 | Editor's Page

Challenges and opportunities of noninvasive cardiac imaging in obesity

Author: Alberto Cuocolo, MD

Published in: Journal of Nuclear Cardiology | Issue 6/2016

Login to get access

Excerpt

Numerous evidences support obesity as both an independent risk factor and a risk marker for the development of asymptomatic and symptomatic coronary artery disease (CAD), heart failure, and atrial fibrillation.1 Diagnosis and risk stratification of cardiovascular impairment in obese population are important to identify those subjects who might benefit from more straight therapeutic strategies. Yet, noninvasive cardiac imaging techniques have restraints in obese subjects and the diagnostic accuracy is often limited. When physical exercise is used as stressor, the poor exercise tolerance leads to underestimation of inducible ischemia. The poor acoustic window for ultrasound in patients with obesity affects the performance of echocardiography in depiction of global and regional motion, thickness, and function of left ventricle. The excess soft tissue attenuation of radioactivity frequently produces artifactual myocardial perfusion defects and poor signal-to-noise ratios for single-photon emission computed tomography (SPECT) imaging.2 The value of attenuation correction is easy to accept, and it is generally recognized that it is important to discern if a tracer deficit is due to diminished myocardial perfusion or if it is an attenuation or motion artifact. Another problem is to establish whether the defect is really reversible or represents a result of scatter and interference from extracardiac tracer activity. It seems conceivable that attenuation correction should at least improve the problems related with an attenuation artifact. However, the question of whether attenuation correction is needed is still unsolved and it has been debated for a long time.3 Gantry bore and table weight limits also affect the ability to accommodate high grade obese on conventional SPECT or positron emission tomography (PET). Hence, it is critical to identify noninvasive imaging modalities with preserved diagnostic and prognostic values irrespective of inpatients’ body mass index (BMI). …
Literature
1.
go back to reference Mandviwala T, Khalid U, Deswal A. Obesity and cardiovascular disease: A risk factor or a risk marker? Curr Atheroscler Rep 2016;18:21.CrossRefPubMed Mandviwala T, Khalid U, Deswal A. Obesity and cardiovascular disease: A risk factor or a risk marker? Curr Atheroscler Rep 2016;18:21.CrossRefPubMed
2.
go back to reference Lim SP, Arasaratnam P, Chow BJ, Beanlands RS, Hessian RC. Obesity and the challenges of noninvasive imaging for the detection of coronary artery disease. Can J Cardiol 2015;31:223–6.CrossRefPubMed Lim SP, Arasaratnam P, Chow BJ, Beanlands RS, Hessian RC. Obesity and the challenges of noninvasive imaging for the detection of coronary artery disease. Can J Cardiol 2015;31:223–6.CrossRefPubMed
3.
go back to reference Cuocolo A. Attenuation correction for myocardial perfusion SPECT imaging: Still a controversial issue. Eur J Nucl Med Mol Imaging 2011;38:1887–9.CrossRefPubMed Cuocolo A. Attenuation correction for myocardial perfusion SPECT imaging: Still a controversial issue. Eur J Nucl Med Mol Imaging 2011;38:1887–9.CrossRefPubMed
4.
go back to reference Cerqueira MD, Nguyen P, Staehr P, Underwood SR, Iskandrian AE, ADVANCE-MPI Trial Investigators. Effects of age, gender, obesity, and diabetes on the efficacy and safety of the selective A2A agonist regadenoson versus adenosine in myocardial perfusion imaging integrated ADVANCE-MPI trial results. JACC Cardiovasc Imaging 2008;1:307–16.CrossRefPubMed Cerqueira MD, Nguyen P, Staehr P, Underwood SR, Iskandrian AE, ADVANCE-MPI Trial Investigators. Effects of age, gender, obesity, and diabetes on the efficacy and safety of the selective A2A agonist regadenoson versus adenosine in myocardial perfusion imaging integrated ADVANCE-MPI trial results. JACC Cardiovasc Imaging 2008;1:307–16.CrossRefPubMed
5.
go back to reference Schindler TH, Cardenas J, Prior JO, Facta AD, Kreissl MC, Zhang XL, et al. Relationship between increasing body weight, insulin resistance, inflammation, adipocytokine leptin, and coronary circulatory function. J Am Coll Cardiol 2006;47:1188–95.CrossRefPubMed Schindler TH, Cardenas J, Prior JO, Facta AD, Kreissl MC, Zhang XL, et al. Relationship between increasing body weight, insulin resistance, inflammation, adipocytokine leptin, and coronary circulatory function. J Am Coll Cardiol 2006;47:1188–95.CrossRefPubMed
6.
go back to reference Quercioli A, Montecucco F, Pataky Z, Thomas A, Ambrosio G, Staub C, et al. Improvement in coronary circulatory function in morbidly obese individuals after gastric bypass-induced weight loss: Relation to alterations in endocannabinoids and adipocytokines. Eur Heart J 2013;34:2063–73.CrossRefPubMed Quercioli A, Montecucco F, Pataky Z, Thomas A, Ambrosio G, Staub C, et al. Improvement in coronary circulatory function in morbidly obese individuals after gastric bypass-induced weight loss: Relation to alterations in endocannabinoids and adipocytokines. Eur Heart J 2013;34:2063–73.CrossRefPubMed
7.
go back to reference Bateman TM, Maddahi J, Udelson J, Beanlands R, Knuuti J, Heller G, et al. Improved assessment of CAD in obese subjects with flurpiridaz F18 PET myocardial perfusion imaging: A subset analysis of the flurpiridaz F18 301 phase 3 study. J Am Coll Cardiol 2016;67:1578.CrossRef Bateman TM, Maddahi J, Udelson J, Beanlands R, Knuuti J, Heller G, et al. Improved assessment of CAD in obese subjects with flurpiridaz F18 PET myocardial perfusion imaging: A subset analysis of the flurpiridaz F18 301 phase 3 study. J Am Coll Cardiol 2016;67:1578.CrossRef
8.
go back to reference Schindler TH. Positron-emitting myocardial blood flow tracers and clinical potential. Prog Cardiovasc Dis 2015;57:588–606.CrossRefPubMed Schindler TH. Positron-emitting myocardial blood flow tracers and clinical potential. Prog Cardiovasc Dis 2015;57:588–606.CrossRefPubMed
9.
go back to reference Nakazato R, Tamarappoo BK, Kang X, Wolak A, Kite F, Hayes SW, et al. Quantitative upright-supine high-speed SPECT myocardial perfusion imaging for detection of coronary artery disease: Correlation with invasive coronary angiography. J Nucl Med 2010;51:1724–31.CrossRefPubMedPubMedCentral Nakazato R, Tamarappoo BK, Kang X, Wolak A, Kite F, Hayes SW, et al. Quantitative upright-supine high-speed SPECT myocardial perfusion imaging for detection of coronary artery disease: Correlation with invasive coronary angiography. J Nucl Med 2010;51:1724–31.CrossRefPubMedPubMedCentral
10.
go back to reference Petretta M, Storto G, Pellegrino T, Bonaduce D, Cuocolo A. Quantitative assessment of myocardial blood flow with SPECT. Prog Cardiovasc Dis 2015;57:607–14.CrossRefPubMed Petretta M, Storto G, Pellegrino T, Bonaduce D, Cuocolo A. Quantitative assessment of myocardial blood flow with SPECT. Prog Cardiovasc Dis 2015;57:607–14.CrossRefPubMed
11.
go back to reference Pellegrino T, Piscopo V, Boemio A, Russo B, De Matteis G, Pellegrino S, et al. Impact of obesity and acquisition protocol on (123)I-metaiodobenzylguanidine indexes of cardiac sympathetic innervation. Quant Imaging Med Surg 2015;5:822–8.PubMedPubMedCentral Pellegrino T, Piscopo V, Boemio A, Russo B, De Matteis G, Pellegrino S, et al. Impact of obesity and acquisition protocol on (123)I-metaiodobenzylguanidine indexes of cardiac sympathetic innervation. Quant Imaging Med Surg 2015;5:822–8.PubMedPubMedCentral
Metadata
Title
Challenges and opportunities of noninvasive cardiac imaging in obesity
Author
Alberto Cuocolo, MD
Publication date
01-12-2016
Publisher
Springer US
Published in
Journal of Nuclear Cardiology / Issue 6/2016
Print ISSN: 1071-3581
Electronic ISSN: 1532-6551
DOI
https://doi.org/10.1007/s12350-016-0676-z

Other articles of this Issue 6/2016

Journal of Nuclear Cardiology 6/2016 Go to the issue