Challenges in Cardiac Risk Stratification for Bariatric Surgery: A Single-Centre Experience

Area of Science:

• Cardiology
• Nuclear Medicine
• Bariatric Surgery

Background:

• Preoperative cardiac risk stratification for bariatric surgery is challenging due to high body mass index (BMI) impacting echocardiography (ECHO) quality.
• Technetium-99m tetrofosmin single-photon emission computed tomography (SPECT) is explored as an alternative imaging modality.

Purpose of the Study:

• To evaluate the diagnostic yield of SPECT compared to ECHO in bariatric surgery candidates.
• To assess the contribution of SPECT-derived information to preoperative decision-making.

Main Methods:

• Retrospective analysis of 66 adults undergoing bariatric surgery evaluated with SPECT and/or ECHO (2017-2024).
• Analysis of imaging findings, inter-modality agreement, downstream testing, and surgical outcomes using correlation, Bland-Altman plots, chi-squared, and logistic regression.

Main Results:

• High cardiometabolic burden observed (hypertension 60.9%, OSA 57.8%, diabetes 56.3%, CAD 16.7%).
• ECHO image quality was limited in 44.4% of attempts.
• SPECT identified ischemia in 31.8% of patients and showed poor ejection fraction agreement with ECHO.

Conclusions:

• SPECT provided additional perfusion and functional data when ECHO quality was limited in this high-risk bariatric cohort.
• The study's limitations (retrospective, small sample, single-center, low event rate) preclude definitive conclusions on clinical utility.
• Prospective evaluation of SPECT in high-risk bariatric patients is recommended to define its role in preoperative cardiac assessment.