Accuracy and usefulness of atrial pacing in conjunction with transthoracic echocardiography in the detection of cardiac ischemia

• Published in: The American journal of cardiology Vol. 77; no. 2; pp. 187 - 190
• Main Authors: Don Michael, T.Anthony, Antonescu, Adrian, Bhambi, Brijesh, Balasingam, Saras
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15.01.1996; Elsevier; Elsevier Limited
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cardiac Pacing, Artificial; Cardiology. Vascular system; Coronary Angiography; Coronary heart disease; Echocardiography - methods; Electrocardiography; Female; Heart; Heart Atria; Humans; Male; Medical research; Medical sciences; Middle Aged; Myocardial Ischemia - diagnostic imaging; Predictive Value of Tests; Radionuclide Imaging; Scientific imaging; Sensitivity and Specificity; Thorax; Radionuclide study; Sonography; Human; Atrium; Echocardiography; Electrical stimulus; Cardiovascular disease; Exploration; Coronary heart disease; Myocardial disease; Photon; Vascular disease; Ischemia; Myocardium; Comparative study; Emission tomography
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/S0002-9149(96)90594-9

Transthoracic echocardiography combined with transesophageal atrial pacing was performed in a community outpatient setting and compared with single-photon emission computed tomography (SPECT) and with coronary arteriography to determine the accuracy and usefulness of the technique. Two groups were defined: group A consisted of 65 of 189 patients who underwent all 3 procedures within a 90-day period; group B consisted of 53 patients who had atrial pacing with transthoracic echocardiography. Seventy-one patients had previously undergone atrial pacing with simultaneous transesophageal echocardiograpny. Atrial pacing to induce abnormal wall morion as an indicator of ischemia was performed by increasing the double product to >20,000. We obtained a sensitivity and specificity of 87% and 88% for group A and 72% and 80% for group B, respectively. We believe that transthoracic echocardiography with atrial pacing is indicated as a means of stress echocardiography in its own right, especially in nonambulatory and chronotropically incompetent patients, as well as in the presence of an ambiguous result on SPECT testing. It is highly accurate compared with our previous study with atrial pacing and simultaneous transesophageal echocardiography, better tolerated, more easily accepted, less invasive, and less costly. Thus, it is a useful stress modality in the detection of myocardial ischemia.