A Review of the Roles and Limitations of Noninvasive Imaging Methods for Investigating Cardiovascular Disease in Individuals with Obesity

Body weight has increased worldwide, characterizing a pandemic of overweight and obesity. Obesity is associated with several risk factors for cardiovascular disease. However, the association between increased body weight and cardiovascular disease is independent of the presence of classical cardiovascular disease risk factors. The direct effects of excessive fat tissue on the heart can cause a specific obesity-related cardiomyopathy in the absence of hypertension, coronary heart disease, and other structural heart diseases. Hemodynamic and structural changes contribute to obesity cardiomyopathy. The changes culminate in diastolic dysfunction, and eventually systolic dysfunction and heart failure. Several cellular cardiac changes have been described in obesity. Patients with obesity often present symptoms such as dyspnea, fatigue, lower limb edema, and chest pain. Noninvasive imaging techniques are important in assessing cardiovascular risk and evaluating symptoms. However, excess adiposity may be challenging for cardiac imaging interpretation and diagnostic accuracy. This review aims to discuss the current roles and limitations of noninvasive imaging diagnostic methods for investigating cardiovascular disease in individuals with obesity. The methods discussed include electrocardiography, echocardiography, 2-dimensional speckle tracking echocardiography, real-time 3-dimensional echocardiography, transesophageal echocardiography, computed tomography and coronary computed tomography angiography, cardiovascular magnetic resonance, stress tests ergometry, stress echocardiography, transesophageal echocardiography with pharmacological stress, stress computed tomography, stress cardiac magnetic resonance, single-photon emission computerized tomography myocardial perfusion imaging, and positron emission tomography. Although the appropriate choice of tests depends on the knowledge of methods and their limitations, patient management should be tailored according to clinical evaluation and technique availability.