Choice of imaging modality in the assessment of coronary artery disease risk in extreme obesity.
Choice of imaging modality in the assessment of coronary artery disease risk in extreme obesity.
复制标题
评估极度肥胖者冠状动脉疾病风险的成像方式选择。
DOI：
10.1038/oby.2009.150
复制
发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Irani,WaleedN
中科院分区：
文献类型：
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作者：
Dunn,JuliaP;Huizinga,MaryM;See,Raphael;Irani,WaleedN
目前的肥胖流行是对冠状动脉疾病（CAD）增加的繁重预测的原因(1)。极度肥胖（EO）（3级肥胖，BMI≥40 kg/m2）发生率为1 / 20的美国成年人，这一人群尤其面临健康状况不佳和医疗保健成本增加的风险(2)。冠心病及其危险因素包括糖尿病、高胆固醇和高血压，随着体重的增加而增加（3,4）。因此，在冠心病发病率和死亡率较高的人群中进行准确的风险评估和分层是至关重要的。尽管风险增加，但在EO人群中评估CAD提出了独特的挑战。与CAD相关的症状，如呼吸困难和运动耐量降低，在伴有或不伴有明显CAD的极度肥胖患者中出现的频率很高(5)，这可能降低病史和体格检查的敏感性和特异性。在2级和3级肥胖队列中，69-87%的患者在爬两段楼梯时出现呼吸困难，12-24%的患者在洗澡或穿衣时出现呼吸困难(5)。确定该队列中运动耐量降低的病因还与久坐生活方式的流行程度增加有关
The current obesity epidemic is res ponsible for a burdensome prediction of increased coronary artery disease (CAD)(1). Extreme obesity (EO)(class 3 obe sity, BMI≥ 40 kg/m2) occurs in 1 in 20 American adults, and this population is especially at risk of poor health out comes and increased cost of health care (2). CAD and its risk factors including diabetes mellitus, high blood cholesterol, and high blood pressure increase across weight classes (3, 4). It is therefore of utmost importance that accurate risk assessment and stratification is able to be performed in this population at risk for greater morbidity and mortality from CAD.Despite as increased risk, evaluation of CAD in the EO population presents unique challenges. Symptoms con cerning for CAD, such as dyspnea and reduced exercise tolerance, occur at a high frequency in those with extreme obesity with or without the presence of significant CAD (5), and may lower the sensitivity and specificity of the history and physical exam. In a cohort of class 2 and 3 obesity, dyspnea climbing two flights of stairs occurred in 69–87% and with bathing or dressing in 12–24% of patients (5). Determining the etiology of reduced exercise tolerance in this cohort is further confounded by increased prevalence of sedentary lifestyle as well