Effects of obesity on noninvasive test results in patients with suspected cardiac ischemia: Insights from the PROMISE trial

the PROMISE Investigators

Research output: Contribution to journalArticle

Abstract

Background: Obesity is a risk factor for coronary artery disease (CAD), but adiposity may mimic symptoms of CAD and reduce the accuracy of diagnostic testing. Methods: Patients from the PROMISE trial (n = 8889) were classified according to body mass index (BMI). We assessed relationships between BMI, physician's preference of functional test, test positivity, and results of invasive coronary angiography (Cath) using logistic regression models. Results: Nearly half (48%) of the patients had BMI ≥ 30 kg/m 2 , and 20% had BMI ≥ 35. Providers were more likely to prefer nuclear myocardial perfusion imaging (MPI) over other functional tests as BMI increased. The rate of test positivity with coronary computed tomographic angiography (CTA) was not different (10% vs. 12%) in patients with BMI ≥35 vs. < 35. The same was true for stress echocardiogram and stress electrocardiogram (positivity 8–13%, P > 0.8 for both). In contrast, MPI was significantly more likely to be positive in those with BMI ≥35 vs. <35 (18% vs. 13%; P = 0.001). The likelihood of obstructive CAD at Cath did not differ with BMI ≥35 vs. <35 in patients having CTA (52% vs. 59%, P = 0.22), but among MPI patients, Cath positivity was only 29% with BMI ≥35 vs. 48% with BMI <35 (P = 0.005). Radiation exposure increased with higher BMI in both MPI and CTA groups. Conclusions: Increasing levels of obesity adversely affect the diagnostic yield of MPI more than CTA. The degree of obesity should be considered when choosing evaluation strategies for patients with chest pain. Clinical Trial Registration: PROMISE ClinicalTrials.gov number, NCT01174550 Obesity may mimic symptoms of CAD and reduce the accuracy of diagnostic testing. In the PROMISE trial (n = 8889), 20% of patients had BMI ≥ 35. The rate of test positivity with coronary CTA was not different (10% vs. 12%) in patients with BMI ≥35 vs. < 35. In contrast, MPI was significantly more likely to be positive in those with BMI ≥35 vs. <35 (18% vs. 13%; P = 0.001). Among MPI patients undergoing invasive angiography, obstructive CAD was found in only 29% with BMI ≥35 vs. 48% with BMI <35 (P = 0.005). The findings suggest that increasing obesity affects the results of CTA less than MPI. Obesity should be taken into account when choosing chest pain evaluation strategies.

Original languageEnglish (US)
JournalJournal of Cardiovascular Computed Tomography
DOIs
StatePublished - Jan 1 2019

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Body Mass Index
Ischemia
Obesity
Myocardial Perfusion Imaging
Angiography
Coronary Artery Disease
Chest Pain
Logistic Models
Adiposity
Coronary Angiography
Clinical Trials
Physicians

Keywords

  • Angina
  • Chest pain
  • Coronary computed tomography angiography
  • Obesity
  • Single photon emission computed tomography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{100b29ce14b24baa8f7006c7ec582b86,
title = "Effects of obesity on noninvasive test results in patients with suspected cardiac ischemia: Insights from the PROMISE trial",
abstract = "Background: Obesity is a risk factor for coronary artery disease (CAD), but adiposity may mimic symptoms of CAD and reduce the accuracy of diagnostic testing. Methods: Patients from the PROMISE trial (n = 8889) were classified according to body mass index (BMI). We assessed relationships between BMI, physician's preference of functional test, test positivity, and results of invasive coronary angiography (Cath) using logistic regression models. Results: Nearly half (48{\%}) of the patients had BMI ≥ 30 kg/m 2 , and 20{\%} had BMI ≥ 35. Providers were more likely to prefer nuclear myocardial perfusion imaging (MPI) over other functional tests as BMI increased. The rate of test positivity with coronary computed tomographic angiography (CTA) was not different (10{\%} vs. 12{\%}) in patients with BMI ≥35 vs. < 35. The same was true for stress echocardiogram and stress electrocardiogram (positivity 8–13{\%}, P > 0.8 for both). In contrast, MPI was significantly more likely to be positive in those with BMI ≥35 vs. <35 (18{\%} vs. 13{\%}; P = 0.001). The likelihood of obstructive CAD at Cath did not differ with BMI ≥35 vs. <35 in patients having CTA (52{\%} vs. 59{\%}, P = 0.22), but among MPI patients, Cath positivity was only 29{\%} with BMI ≥35 vs. 48{\%} with BMI <35 (P = 0.005). Radiation exposure increased with higher BMI in both MPI and CTA groups. Conclusions: Increasing levels of obesity adversely affect the diagnostic yield of MPI more than CTA. The degree of obesity should be considered when choosing evaluation strategies for patients with chest pain. Clinical Trial Registration: PROMISE ClinicalTrials.gov number, NCT01174550 Obesity may mimic symptoms of CAD and reduce the accuracy of diagnostic testing. In the PROMISE trial (n = 8889), 20{\%} of patients had BMI ≥ 35. The rate of test positivity with coronary CTA was not different (10{\%} vs. 12{\%}) in patients with BMI ≥35 vs. < 35. In contrast, MPI was significantly more likely to be positive in those with BMI ≥35 vs. <35 (18{\%} vs. 13{\%}; P = 0.001). Among MPI patients undergoing invasive angiography, obstructive CAD was found in only 29{\%} with BMI ≥35 vs. 48{\%} with BMI <35 (P = 0.005). The findings suggest that increasing obesity affects the results of CTA less than MPI. Obesity should be taken into account when choosing chest pain evaluation strategies.",
keywords = "Angina, Chest pain, Coronary computed tomography angiography, Obesity, Single photon emission computed tomography",
author = "{the PROMISE Investigators} and Litwin, {Sheldon E.} and Adrian Coles and Neha Pagidipati and Lee, {Kerry L.} and Patricia Pellikka and Mark, {Daniel B.} and Udelson, {James E.} and Udo Hoffmann and Douglas, {Pamela S.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jcct.2019.03.010",
language = "English (US)",
journal = "Journal of Cardiovascular Computed Tomography",
issn = "1934-5925",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Effects of obesity on noninvasive test results in patients with suspected cardiac ischemia

T2 - Insights from the PROMISE trial

AU - the PROMISE Investigators

AU - Litwin, Sheldon E.

AU - Coles, Adrian

AU - Pagidipati, Neha

AU - Lee, Kerry L.

AU - Pellikka, Patricia

AU - Mark, Daniel B.

AU - Udelson, James E.

AU - Hoffmann, Udo

AU - Douglas, Pamela S.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Obesity is a risk factor for coronary artery disease (CAD), but adiposity may mimic symptoms of CAD and reduce the accuracy of diagnostic testing. Methods: Patients from the PROMISE trial (n = 8889) were classified according to body mass index (BMI). We assessed relationships between BMI, physician's preference of functional test, test positivity, and results of invasive coronary angiography (Cath) using logistic regression models. Results: Nearly half (48%) of the patients had BMI ≥ 30 kg/m 2 , and 20% had BMI ≥ 35. Providers were more likely to prefer nuclear myocardial perfusion imaging (MPI) over other functional tests as BMI increased. The rate of test positivity with coronary computed tomographic angiography (CTA) was not different (10% vs. 12%) in patients with BMI ≥35 vs. < 35. The same was true for stress echocardiogram and stress electrocardiogram (positivity 8–13%, P > 0.8 for both). In contrast, MPI was significantly more likely to be positive in those with BMI ≥35 vs. <35 (18% vs. 13%; P = 0.001). The likelihood of obstructive CAD at Cath did not differ with BMI ≥35 vs. <35 in patients having CTA (52% vs. 59%, P = 0.22), but among MPI patients, Cath positivity was only 29% with BMI ≥35 vs. 48% with BMI <35 (P = 0.005). Radiation exposure increased with higher BMI in both MPI and CTA groups. Conclusions: Increasing levels of obesity adversely affect the diagnostic yield of MPI more than CTA. The degree of obesity should be considered when choosing evaluation strategies for patients with chest pain. Clinical Trial Registration: PROMISE ClinicalTrials.gov number, NCT01174550 Obesity may mimic symptoms of CAD and reduce the accuracy of diagnostic testing. In the PROMISE trial (n = 8889), 20% of patients had BMI ≥ 35. The rate of test positivity with coronary CTA was not different (10% vs. 12%) in patients with BMI ≥35 vs. < 35. In contrast, MPI was significantly more likely to be positive in those with BMI ≥35 vs. <35 (18% vs. 13%; P = 0.001). Among MPI patients undergoing invasive angiography, obstructive CAD was found in only 29% with BMI ≥35 vs. 48% with BMI <35 (P = 0.005). The findings suggest that increasing obesity affects the results of CTA less than MPI. Obesity should be taken into account when choosing chest pain evaluation strategies.

AB - Background: Obesity is a risk factor for coronary artery disease (CAD), but adiposity may mimic symptoms of CAD and reduce the accuracy of diagnostic testing. Methods: Patients from the PROMISE trial (n = 8889) were classified according to body mass index (BMI). We assessed relationships between BMI, physician's preference of functional test, test positivity, and results of invasive coronary angiography (Cath) using logistic regression models. Results: Nearly half (48%) of the patients had BMI ≥ 30 kg/m 2 , and 20% had BMI ≥ 35. Providers were more likely to prefer nuclear myocardial perfusion imaging (MPI) over other functional tests as BMI increased. The rate of test positivity with coronary computed tomographic angiography (CTA) was not different (10% vs. 12%) in patients with BMI ≥35 vs. < 35. The same was true for stress echocardiogram and stress electrocardiogram (positivity 8–13%, P > 0.8 for both). In contrast, MPI was significantly more likely to be positive in those with BMI ≥35 vs. <35 (18% vs. 13%; P = 0.001). The likelihood of obstructive CAD at Cath did not differ with BMI ≥35 vs. <35 in patients having CTA (52% vs. 59%, P = 0.22), but among MPI patients, Cath positivity was only 29% with BMI ≥35 vs. 48% with BMI <35 (P = 0.005). Radiation exposure increased with higher BMI in both MPI and CTA groups. Conclusions: Increasing levels of obesity adversely affect the diagnostic yield of MPI more than CTA. The degree of obesity should be considered when choosing evaluation strategies for patients with chest pain. Clinical Trial Registration: PROMISE ClinicalTrials.gov number, NCT01174550 Obesity may mimic symptoms of CAD and reduce the accuracy of diagnostic testing. In the PROMISE trial (n = 8889), 20% of patients had BMI ≥ 35. The rate of test positivity with coronary CTA was not different (10% vs. 12%) in patients with BMI ≥35 vs. < 35. In contrast, MPI was significantly more likely to be positive in those with BMI ≥35 vs. <35 (18% vs. 13%; P = 0.001). Among MPI patients undergoing invasive angiography, obstructive CAD was found in only 29% with BMI ≥35 vs. 48% with BMI <35 (P = 0.005). The findings suggest that increasing obesity affects the results of CTA less than MPI. Obesity should be taken into account when choosing chest pain evaluation strategies.

KW - Angina

KW - Chest pain

KW - Coronary computed tomography angiography

KW - Obesity

KW - Single photon emission computed tomography

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U2 - 10.1016/j.jcct.2019.03.010

DO - 10.1016/j.jcct.2019.03.010

M3 - Article

AN - SCOPUS:85063688691

JO - Journal of Cardiovascular Computed Tomography

JF - Journal of Cardiovascular Computed Tomography

SN - 1934-5925

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