Heavy matters: prognostic value of stress echocardiography in morbidly obese patients (SEBO study)

Background and Objectives The global prevalence of morbid obesity is steadily increasing, posing a challenge for the evaluation of coronary artery disease (CAD). Stress echocardiography (SE) is widely used for ischemic risk stratification, but its specific prognostic value in morbidly obese patients remains unclear. This study aimed to assess the prognostic performance of SE in this high-risk population. Methods We conducted a retrospective cohort study including 44 patients with morbid obesity (body mass index [BMI] ≥ 40) who underwent SE at our center. The primary endpoint was a composite of revascularization, non-fatal myocardial infarction, and all-cause mortality during follow-up. Results The mean age was 66 ± 12 years; 61% were female, with a median BMI of 42.44 (IQR 40.96–45.50). One-third of patients had known CAD. Pharmacological stress was the most common modality (59.06%). Ultrasound contrast agents were used in the majority of cases (70.45%), particularly in pharmacologic SE (96.15% vs. 33.33% in exercise SE, p < 0.001). Only one study was non-diagnostic despite contrast use. Ischemia was detected in 2 patients (4.55%), both of whom had significant CAD confirmed by coronary angiography (positive predictive value: 100%). Among the 42 patients without ischemia, 7 underwent coronary angiography or coronary CT due to persistent symptoms, none showing significant disease. The mean follow-up was 27.73 ± 16.49 months. Five events occurred: 2 in the ischemic group and 3 in the non-ischemic group (100% vs. 7.14%, p < 0.001). The event incidence among patients with negative SE was just 0.03/year. Conclusions Stress echocardiography is a useful diagnostic tool for detecting myocardial ischemia and provides effective mid-term risk stratification in patients with morbid obesity. Its high positive predictive value supports its use in this growing and challenging population.