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Heart, Lung and Circulation

The Effect of Obesity on Echocardiographic Image Quality

Published:August 06, 2021DOI:https://doi.org/10.1016/j.hlc.2021.06.525

      Background

      Increased body mass index (BMI) may reduce transthoracic echocardiogram (TTE) image quality, resulting in increased requirements for ultrasound enhancing agents (UEA), as recommended by the American Society of Echocardiography (ASE), and a greater incidence of non-diagnostic studies.

      Methods

      Over a 5-month period 1,108 TTEs were analysed as to (1) whether they could answer the clinical question posed by the ordering physician (i.e. were diagnostic vs non diagnostic), and (2) whether they required UEAs according to the ASE guidelines. Patient characteristics were gathered from the medical record.

      Results

      12.9% of TTEs were non-diagnostic (21.0% of TTEs in the obese population [BMI≥30 kg/m2] vs 7.8% in the non-obese [p<0.001]). Predictors of a non-diagnostic study were BMI (OR 1.09, [95% CI 1.06–1.11], p<0.0001), male gender (OR 1.54, [1.06–2.25], p=0.02), and inpatient status (OR 1.75, [1.20–2.55], p=0.004). Obesity (BMI≥30) was strongly associated with non-diagnostic studies (OR 3.22, [2.23–4.51], p<0.001). Factors associated with increased requirement of UEAs were BMI (OR 1.10, [1.08–1.12], p<0.0001), age (OR 1.02, [1.01–1.03], p<0.0001) and inpatient status (OR 1.7, [1.29–2.24], p<0.05). Obesity (BMI>30) was strongly associated with contrast requirement (OR 3.16, [2.43–4.10], p<0.0001).

      Conclusions

      Body mass index, male gender and inpatient status were associated with an increased incidence of non-diagnostic studies. Body mass index, age and inpatient status were associated with an increased requirement for UEAs.

      Keywords

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      References

        • Australian Institute of Health and Welfare
        Healthy communities: overweight and obesity rates across Australia, 2014–15. December, 2016.
        https://apo.org.au/node/71898
        Date accessed: September 28, 2020
        • World Health Organisation
        Obesity: preventing and managing the global epidemic : report of a WHO consultation. Geneva: World Health Organization; 2000.
        https://apps.who.int/iris/handle/10665/42330
        Date accessed: September 28, 2020
        • Lavie C.J.
        • Alpert M.A.
        • Arena R.
        • Mehra M.R.
        • Milani R.V.
        • Ventura H.O.
        Impact of obesity and the obesity paradox on prevalence and prognosis in heart failure.
        JACC Heart Fail. 2013; 1: 93-102
        • Lavie C.J.
        • Milani R.V.
        • Ventura H.O.
        Effects of obesity and weight changes on cardiac and vascular structure and function: does the clinical impact carry any weight?.
        JACC Heart Fail. 2014; 2: 509-511
        • Abel E.D.
        • Litwin S.E.
        • Sweeney G.
        Cardiac remodeling in obesity.
        Physiol Rev. 2008; 88: 389-419
        • Heckbert S.R.
        • Post W.
        • Pearson G.D.
        • Arnett D.K.
        • Gomes A.S.
        • Jerosch-Herold M.
        • et al.
        Traditional cardiovascular risk factors in relation to left ventricular mass, volume, and systolic function by cardiac magnetic resonance imaging: the Multiethnic Study of Atherosclerosis.
        J Am Coll Cardiol. 2006; 48: 2285-2292
        • Kenchaiah S.
        • Evans J.C.
        • Levy D.
        • Wilson P.W.
        • Benjamin E.J.
        • Larson M.G.
        • et al.
        Obesity and the risk of heart failure.
        N Engl J Med. 2002; 347: 305-313
        • Tole N.M.
        • Ostensen H.
        • World Health Organization. Diagnostic I, Laboratory Technology T
        Basic physics of ultrasonic imaging/by Nimrod M. Tole; Editor: Harald Ostensen. World Health Organization, Geneva2005
        • Uppot R.N.
        • Sahani D.V.
        • Hahn P.F.
        • Kalra M.K.
        • Saini S.S.
        • Mueller P.R.
        Effect of obesity on image quality: fifteen-year longitudinal study for evaluation of dictated radiology reports.
        Radiology. 2006; 240: 4359
        • Porter T.R.
        • Abdelmoneim S.
        • Belcik J.T.
        • McCulloch M.L.
        • Mulvagh S.L.
        • Olson J.J.
        • et al.
        Guidelines for the cardiac sonographer in the performance of contrast echocardiography: a focused update from the American Society of Echocardiography.
        J Am Soc Echocardiogr. 2014; 27: 797-810
        • Fraiche A.M.
        • Manning W.J.
        • Nagueh S.F.
        • Main M.L.
        • Markson L.J.
        • Strom J.B.
        Identification of Need for Ultrasound Enhancing Agent Study (the IN-USE Study).
        J Am Soc Echocardiogr. 2020;
        • Mulvagh S.L.
        • Rakowski H.
        • Vannan M.A.
        • Abdelmoneim S.S.
        • Becher H.
        • Bierig S.M.
        • et al.
        American Society of Echocardiography Consensus Statement on the Clinical Applications of Ultrasonic Contrast Agents in Echocardiography.
        J Am Soc Echocardiogr. 2008; 21 (quiz 281): 1179-1201
        • Porter T.R.
        • Mulvagh S.L.
        • Abdelmoneim S.S.
        • Becher H.
        • Belcik J.T.
        • Bierig M.
        • et al.
        Clinical applications of ultrasonic enhancing agents in echocardiography: 2018 American Society of Echocardiography Guidelines Update.
        J Am Soc Echocardiogr. 2018; 31: 241-274
        • Shah B.N.
        • Senior R.
        Stress echocardiography in patients with morbid obesity.
        Echo Res Pract. 2016; 3: R13-R18
        • Finkelhor R.S.
        • Moallem M.
        • Bahler R.C.
        Characteristics and impact of obesity on the outpatient echocardiography laboratory.
        Am J Cardiol. 2006; 97: 1082-1084
        • Siadecki S.D.
        • Frasure S.E.
        • Lewiss R.E.
        • Saul T.
        High body mass index is strongly correlated with decreased image quality in focused bedside echocardiography.
        J Emerg Med. 2016; 50: 295-301
        • Yong Y.
        • Wu D.
        • Fernandes V.
        • Kopelen H.A.
        • Shimoni S.
        • Nagueh S.F.
        • et al.
        Diagnostic accuracy and cost-effectiveness of contrast echocardiography on evaluation of cardiac function in technically very difficult patients in the intensive care unit.
        Am J Cardiol. 2002; 89: 711-718
        • Hattori K.
        • Numata N.
        • Ikoma M.
        • Matsuzaka A.
        • Danielson R.R.
        Sex differences in the distribution of subcutaneous and internal fat.
        Hum Biol. 1991 Feb; 63: 53-63
        • García-Martínez D.
        • Torres-Tamayo N.
        • Torres-Sanchez I.
        • García-Río F.
        • Bastir M.
        Morphological and functional implications of sexual dimorphism in the human skeletal thorax.
        Am J Phys Anthropol. 2016 Nov; 161: 467-477