Pacing Stress Echocardiography Research Articles

Feasibility of the assessment of longitudinal systolic deformation of the left ventricle in transesophageal atrial pacing stress echocardiography. Clinical case

The article describes a clinical case of registration of longitudinal systolic deformation of the left ventricle using speckle-t racking technology during stress- echocardiography with transesophageal atrial pacing in a patient with coronary heart disease. A feature of the clinical case is the identification of changes in the longitudinal deformation of the left ventricular not only in the zone of visible local disturbances of myocardial contractility, but also in other zones, followed by the identification of hemodynamically significant stenoses of the coronary arteries, which supply the zones with defective longitudinal deformation of left ventricular, but without visible local disturbances of myocardial contractility. The presented case shows the prospects of using the evaluation of left ventricular deformation indicators during stress echocardiography with transesophageal atrial pacing.

P207 Adjunctive application of handgrip exercise associated with rapid pacing stress echocardiography in patients with implanted pacemakers

Abstract The aim Assessment of safety, diagnostic, and prognostic value of a stress echocardiography protocol based on rapid pacing in patients with implanted permanent pacemakers and concomitant handgrip dynamometer method. There are no data in the literature on this type of modification of the stress test. Methods Rapid pacing stress echo tests with further handgrip were performed in 54 patients (33 females, aged 49-88, mean 72 +/- 8 years), using previously implanted permanent pacemakers. Left ventricular segmental contractility was assessed at rest, during 3 minutes pacing at the rate of 100/minutes, over 5 minutes at 85% of maximal age-predicted heart rate and then further at peak stage per 1 minute with the addition of a handgrip (compression of the dynamometer with a force equal to half the maximum strength of the patient measured before the test). The test was performed using only VVI pacing mode in 16 patients in whom atrial pacing was not possible. In the remaining 38 patients AAI/DDD pacing mode was initially used. Results No severe adverse effects were observed. Significant increase in heart rate comparing to baseline was achieved [74/minutes vs. 127/minutes (P < 00001)]. Wall motion score index increased significantly (from 1.07 vs. 1.15, p < 00001). During the handgrip stage, both systolic (p < 0.0005) and diastolic (p < 0.0001) blood pressure significantly increased. Among all surveys, 18 (33%) were considered positive, 36 (67%) negative. All the examinations were diagnostic. In 35 patients coronary angiography was performed (15 pts with test positive and 20 pts with test negative). Sensitivity, specificity, accuracy, positive, and negative predictive values for significant coronary stenosis were respectively: 61.6%, 68.2%, 65.3%, 53.3%, and 75%. For patients with DM2 the above values were: 83.3%, 85.7%, 84.6%, 83.3%, 85.7%. No statistical differences were observed depending on the type of the device or the use of beta blockers In patients with LMA stenosis test sensitivity was - 100%, with LAD – 62.5%, with CX - 75% and with RCA was 71.5%. Revasculization was required in 8 patiens with test positive and 3 with test negative (p = 0.01). During 6-moth follow-up there was no cardiac death, myocardial infarction or stroke . Conclusions The sensitivity and specificity of the stress test using the pacemaker and the handgrip method for all patients proved to be lower than the values obtained in other stress tests. However, the use of the handgrip method during stimulation caused an increase in mean systolic and diastolic blood pressure. Such an extension makes the pacing stress echo test more physiological. Moreover the stress test using pacemaker and handgrip method proved to be safe and well-tolerated by patients. The prognostic value of the negative result of the study research using stimulation from the patient"s pacemaker and the handgrip method was high in the 6 month follow-up

Stress echocardiography in clinical practice: a United Kingdom National Health Service Survey on behalf of the British Society of Echocardiography

Stress echocardiography (SE) is one of the leading modalities for the assessment of coronary artery disease and dynamic valvular heart disease. A wide range of different techniques have been established. There are no data which identify how current techniques have been integrated into clinical practice. An electronic questionnaire was devised to identify SE practice in five core areas: service demographics, indications, methods, reporting, and adverse events. The questionnaire was sent to 198 National Health Service hospitals. Eighty-five (71%) out of the 120 departments who perform SE responded. Each unit performed a median of 400 SE (inter-quartile range 175-600). Thirty-two (37.6%) operators performed <100 SE per year. Exercise, dobutamine, dipyridamole, adenosine, and pacing SE were available in 57 (67.1%), 85 (100%), 6 (7.1%), 11 (12.9%), and 34 (40%) units, respectively. Eighty-one (95.3%) units performed SE for the evaluation of low-flow, low-gradient aortic stenosis. Thirty-four (40%) and 32 (37.6%) performed SE for the evaluation of asymptomatic severe aortic stenosis and symptomatic moderate mitral regurgitation, respectively. Eighty-three (97.6%) administered contrast agents during SE. Additional analysis of perfusion and strain was performed in 9 (10.5%) and 13 (15.3%) units, respectively. SE has been incorporated into the majority of UK hospitals. A substantial proportion of operators perform less than the recommended number of procedures per year. The use of exercise SE, vasodilator SE, and SE for the evaluation of VHD are under-utilized. Penetration of new techniques is variable, contrast for left ventricular opacification has been almost universally adopted, while myocardial perfusion and mechanics are used much less.

Accuracy and Long-Term Prognostic Value of Pacing Stress Echocardiography Compared with Dipyridamole Tl201 Emission Computed Tomography in Patients with a Permanent Pacemaker and Known or Suspected Coronary Artery Disease

Objectives: Myocardial ischemia is difficult to assess by noninvasive methods in patients with a permanent pacemaker. Pacing stress echocardiography (PASE) has been used successfully in the detection of coronary artery disease (CAD). However, there are no data comparing PASE and other methods. Methods: We compared agreement and accuracy of PASE and radionuclide tomography (SPECT) in detecting CAD in 58 patients, mean age 75 ± 7 years, with a permanent pacemaker and known or suspected CAD. Thirty-nine patients underwent coronary angiography. The prognostic value of these tests was determined by prediction of cardiac events and cardiac death. Results: PASE and SPECT were positive in 39 and 43 patients, respectively. The agreement between the tests was 75%; kappa value 0.64. The sensitivity was 87 and 96% and the specificity 78 and 57%, respectively. With median follow-up of 51 months, there were 24 cardiac events and 8 cardiac deaths. Multivariable analysis determined that positive PASE was the only independent predictive factor associated with cardiac events and cardiac death. Conclusions: PASE is a feasible and effective method for detection of significant CAD in patients with permanent-pacemaker and allows effective risk stratification. PASE merits further study in larger prospective comparative studies.

Diagnostic and Prognostic Value of Rapid Pacing Stress Echocardiography for the Detection of Coronary Artery Disease: Influence of Pacing Mode and Concomitant Antiischemic Therapy (Final Results of Multicenter Study Pol‐RAPSE)

Assessment of safety, diagnostic, and prognostic value of a stress echocardiography protocol based on rapid pacing in patients with implanted permanent pacemakers according to the pacing mode (AAI/DDD or VVI) and concomitant antiischemic therapy. 149 rapid pacing stress echo tests were performed in 100 patients (33 females, 67 males, aged 47-79, mean 65 +/- 8 years), utilizing previously implanted permanent pacemakers. Left ventricular segmental contractility was assessed at rest, during pacing at the rate of 100/minutes and then at 85% of maximal age-predicted heart rate. Each pacing stage lasted for 3 minutes. The test was performed using only VVI pacing mode in 27 patients in whom atrial pacing was not possible. In the remaining 73 patients AAI/DDD pacing mode was initially used in all 73 patients and followed by VVI pacing in 49 patients. Angiographic coronary stenosis of at least 50% was considered significant. No severe adverse effects were observed. Mean duration of the test was 7 +/- 2 minutes for VVI pacing and 10 +/- 2 minutes for both AAI/DDD and VVI pacing. Among 149 tests performed, AAI/DDD mode was used in 73 (49%), while in VVI mode was used in 76 (51%) tests. Significant increase in heart rate comparing to baseline was achieved[[68/minutes vs. 129/minutes (P < 00001)]], also in patients treated with beta-blockers[[69/minutes vs. 129/minutes (P < 00001)]], whereas, blood pressure remained unchanged between rest and rapid pacing stage. Wall motion score index increased significantly (from 1.32 vs. 1.49 in AAI/DDD to 1.36 vs. 1.65 in VVI mode). Among all 149 tests, 89 (60%) were considered positive, 57 (38%) negative, and 3 (2%) - nondiagnostic. Sensitivity, specificity, accuracy, positive, and negative predictive values for significant coronary stenosis were respectively: 91%, 75%, 83%, 81%, and 88%. For AAI/DDD mode the above values were: 91%, 81%, 86%, 82%, 91%, while for VVI mode they were: 91%, 68%, 80%, 80%, 84% (ns). In patients treated with beta-blockers test accuracy was - 79%., with ACE inhibitors - 84%, and with nitrates - 93%. During 1-year follow-up 5 (5%) cardiac deaths and 9 (9,1%) myocardial infarctions occurred. The risk of myocardial infarction or cardiac death was significantly higher in patients with positive comparing to negative result of RAPSE test. Complications hazard ratio associated with positive result of RAPSE was 13.5 (95% confidence interval, 1.7-106.0, P + 0.0133) for AAI/DDD mode and 7.9 (95% confidence interval, 1.0-60.9, P + 0.00472) for VVI mode. Rapid pacing stress echo test using permanent pacemaker is a rapid and safe diagnostic technique. The accuracy is good for both pacing modes, including tests performed in patients treated with beta-blockers. The test can be utilized as a technique of choice in noninvasive diagnostics of coronary disease and prognostic assessment in patients with permanent pacemakers.

Influence of Gender on Diagnostic Accuracy of Rapid Atrial and Ventricular Pacing Stress Echocardiography for the Detection of Coronary Artery Disease: A Multicenter Study (Pol-RAPSE Final Results)

Rapid cardiac pacing using a permanent pacemaker may be used as a nonpharmacologic stress during echocardiographic imaging for diagnosing coronary artery disease (CAD). We presented the final results of a national multicenter study, the Polish study on Rapid Pacing Stress Echocardiography (Pol-RAPSE), aimed at the assessment of the safety and accuracy of rapid cardiac pacing for the noninvasive diagnosis of CAD in women and men. We have analyzed 149 tests performed in 100 patients with permanent pacemakers (27% ventricular pacing [VVI], 10% atrial pacing [AAI], 63% dual chamber pacing [DDD]) referred for stress echocardiography. All patients underwent coronary angiography as a reference for assessing the accuracy of rapid cardiac pacing stress echocardiography (RAPSE). Significant CAD was defined as luminal diameter reduction more than 50% in at least 1 major epicardial coronary artery. Peak stress was obtained in 73 patients using physiologic stimulation of right atrium by and mode or in 76 patients by VVI mode. Significant CAD was detected by angiography in 46% of women and 57% of men (P = not significant). The feasibility of the test was 98%. Overall accuracy of the test was slightly lower in women than in men (75% vs 88%, P = .04), although there were no significant differences in sensitivity, specificity, and positive and negative predictive values between the genders. In women (n = 48), the accuracy of RAPSE performed in AAI and VVI mode was 79% and 70% with no significant difference and in men was 89% and 87%, respectively (P = not significant). RAPSE is a safe and feasible modality for diagnosing CAD. The method offers slightly higher accuracy in men compared with women. Overall efficacy is satisfactory with both AAI and VVI pacing, although easier interpretation of peak AAI/DDD images results in a trend toward better accuracy.

Ischemia Induced by Transesophageal Atrial Pacing Stress Echocardiography Predicts Long-Term Mortality

Objectives: It was the aim of this study to investigate the long-term value of transesophageal atrial pacing in predicting death in patients with known or suspected coronary artery disease. Background: Exercise, dobutamine and dipyridamole stress echocardiography are all effective in predicting cardiac death. Transesophageal atrial pacing stress echocardiography (TAPSE) is a safe alternative to pharmacologic tests, but no information is available on prognosis with TAPSE. Methods: One thousand and ten TAPSE were performed in 975 consecutive patients. TAPSE was feasible in 970 tests (96%); after exclusion of the 35 patients with more than 1 TAPSE and those 42 lost at follow-up (mean 4.5 ± 3.7 years, median 6 years), the final population consisted of 857 patients (675 males, 58 ± 9 years old). The Cox model was used to analyze the association of clinical, resting and TAPSE variables with cardiac death. Results: TAPSE was abnormal in 281 (32%) patients. There were 46 cardiac-related deaths (5%), 25 among the 281 patients with an abnormal test (8.9%) and 21 among the 576 patients with a normal test (3.6%). The predictors of cardiac death were age, previous revascularization, resting wall motion score index and its variation during TAPSE. Abnormal TAPSE significantly increases the value of models predicting cardiac death. Moreover, cardiac mortality increased progressively with the extent of the induced ischemia. Conclusions: TAPSE is a useful tool in predicting death in patients with known or suspected coronary artery disease and might be considered an alternative to pharmacologic stressors.

Safety of Stress Echocardiography Supervised by Registered Nurses: Results of a 2-Year Audit of 15,404 Patients

Stress echocardiography has traditionally been performed under the supervision of physicians. In the last decade, at some institutions, specially trained registered nurses have taken on the task of directly supervising and conducting these stress tests with appropriate physician involvement and assistance. The safety of 15,404 stress echocardiograms that were performed under the direct supervision of registered nurses during a recent 2-year period was evaluated. The stress modality was treadmill exercise in 8592 (56%), dobutamine in 6755 (44%), and transesophageal atrial pacing in 57 (0.04%) patients. The mean age was 65 +/- 13 years, and 54% were male. A total of 55 patients (0.36%) had complications related to stress echocardiography, including 26 patients (0.18%) who were subsequently transferred to hospital. Complications included atrial fibrillation (n = 28, 0.18%), other supraventricular tachycardias (n = 9, 0.06%), sustained ventricular tachycardia (n = 4, 0.03%), and ventricular fibrillation (n = 2, 0.01%). Eight patients (0.05%) were hospitalized for markedly positive tests or prolonged chest pain and 4 patients (0.03%) for symptomatic hypotension. No patient had cardiac rupture or died. Complications were more common with dobutamine stress echocardiography (DSE) (47/6755; 0.7%) compared with exercise echocardiography (8/8592; 0.09%) or transesophageal atrial pacing stress echocardiography (0/57) (P < .0001). Arrhythmias were more commonly associated with DSE (39/6755, 0.58%) than exercise echocardiography (4/8592, 0.05%). Potentially life-threatening ventricular arrhythmias occurred in 6 of 6755 patients who underwent DSE (0.09%) and in none of the patients who underwent exercise echocardiography. Patients who underwent DSE were, on average, older, and had more comorbidities compared with those who underwent exercise echocardiography. Stress echocardiography, when supervised directly by specially trained registered nurses, can be performed safely; complications are uncommon (1/280 stress tests) and these complication rates are comparable with previously reported studies evaluating the safety of stress echocardiography supervised by physicians.

A Novel Finding to Assess Ischemia in Pacing Stress Echocardiography (PASE)

Normalization of heart rate post-pacing stress echocardiography (PASE) could enable evaluation of effect of ischemia on diastolic function. We examined the effect of pacing on left ventricular (LV) filling in 55 patients who underwent a transesophageal PASE. Pulse wave Doppler of mitral inflow was obtained at baseline and during transition from peak pacing to up to three beats immediate post pacing. Thirty-four patients (62%; 62 +/- 12 years) had normal (NL) PASE, wall motion score index (WMSI) 1 +/- 0 at baseline and during PASE. Sixteen patients (29%; 64 +/- 12 years) had ischemic (ISCH) PASE, WMSI 1.07 +/- 0.08 at baseline and 1.40 +/- 0.21 during PASE. Five patients (9%; 81 +/- 5 years) had abnormal (ABN) PASE, WMSI 1.55 +/- 0.34 at baseline and 1.55 +/- 0.34 during PASE. The ABN group had the most pronounced decrease in deceleration time (DT) seen in all three post-PASE beats (221 +/- 29 ms at baseline vs. 145 +/- 46, 144 +/- 26 and 144 +/- 18 ms at beats 1, 2, and 3, P < 0.005 from baseline for all). The DT reduced significantly at post-PASE beat 1 from baseline (234 +/- 45 ms vs. 158 +/- 36 ms, P = 0.02) in the ISCH group, whereas no significant change in DT occurred in the NL group (239 +/- 74 ms vs. 222 +/- 58 ms, P = 0.14) at beat 1. In ISCH and ABN ventricles the duration of early diastolic filling decreased post-pacing. This new finding of a shortened deceleration time (DT) may be a marker of an ischemic response in PASE reflecting abnormal LV compliance.

1009 Rapid atrial and ventricular pacing stress echocardiography in coronary artery disease: an alternative technique of stress testing-final results of Polish multicenter study Pol-RAPSE

1009 Rapid atrial and ventricular pacing stress echocardiography in coronary artery disease: an alternative technique of stress testing-final results of Polish multicenter study Pol-RAPSE

Stress Echocardiography in Octogenarians: Transesophageal Atrial Pacing is Accurate, Safe, and Well Tolerated

The feasibility and diagnostic accuracy of transesophageal pacing stress echocardiography for detection of inducible myocardial ischemia were evaluated in 161 patients 80 years of age or older (mean 84 +/- 3.9, range 80-97). The pacing time was 5.5 +/- 2.5 minutes with a total test time of 37 +/- 7 minutes. The mean achieved heart rate was 96 +/- 7% (83%-121%) of maximum predicted with an average rate pressure product of 21,560 +/- 5175 beats/min x mm Hg. There were minor adverse events in 8% of cases and no major complications occurred. Patient acceptance was high. When compared with myocardial single photon emission computed tomography, pacing stress echocardiography had a sensitivity of 89% and a specificity of 93% for the detection of myocardial ischemia, and 91% agreement (kappa = 0.80, P < .001). We demonstrate that pacing stress echocardiography is safe and accurate for detection of myocardial ischemia and, thus, a reliable substitute to exercise and pharmacologic stress testing in octogenarians.

Comparison of the Long-Term Survival Benefits Associated With Revascularization or Medical Therapy in Patients With Known Coronary Artery Disease Undergoing Transesophageal Atrial Pacing Stress Echocardiography

Although the utility of stress echocardiography for the diagnosis and prognostic evaluation of patients with suspected coronary artery disease (CAD) has been widely reported, few studies have evaluated the role of revascularization in relation to the presence of inducible ischemia during stress in patients with known CAD. The study population consisted of 295 consecutive patients who underwent transesophageal atrial pacing stress echocardiography (TAPSE) in the echocardiographic laboratory of our division between January 1988 and September 1997, in whom coronary angiography was performed within 10 days of the test. Patients were then assigned to revascularization or medical treatment according to the treatment given within 60 days of TAPSE. Cardiac-related deaths were higher in medically treated (19 of 135) than in revascularized (8 of 160) patients (p = 0.03). Parameters measured with TAPSE, i.e., positivity of the test, change in wall motion score index (DeltaWMSI and peak WMSI) were significantly related to mortality in medically treated patients but not in revascularized patients. At multivariate analysis, DeltaWMSI remained the most powerful predictor of cardiac death in medically treated patients (p = 0.005). Mortality progressively increased with increments in extent of inducible ischemia among medically treated patients (5 of 71 patients in DeltaWMSI 0, 3 of 27 in DeltaWMSI 0 to 25, 11 of 37 patients in DeltaWMSI >25) but not among revascularized patients (3 of 58 patients in DeltaWMSI 0, 2 of 51 in DeltaWMSI 0 to 25, 3 of 51 patients in DeltaWMSI >25). The survival curve in medically treated patients with ischemia in a remote zone (24 patients, 8 deaths) was worse than in other groups of medically treated patients (41 patients, 6 deaths). In conclusion, in patients with known CAD, the presence and extent of ischemia as evaluated with TAPSE worsens survival, if revascularization is not performed. In patients without ischemia at TAPSE, revascularization or medical therapy are equally effective.

Pacing stress echocardiography

BackgroundHigh-rate pacing is a valid stress test to be used in conjunction with echocardiography; it is independent of physical exercise and does not require drug administration. There are two main applications of pacing stress in the echo lab: the noninvasive detection of coronary artery disease through induction of a regional transient dysfunction; and the assessment of contractile reserve through peak systolic pressure/ end-systolic volume relationship at increasing heart rates to assess global left ventricular contractility.MethodsThe pathophysiologic rationale of pacing stress for noninvasive detection of coronary artery disease is obvious, with the stress determined by a controlled increase in heart rate, which is a major determinant of myocardial oxygen demand, and thereby tachycardia may exceed a fixed coronary flow reserve in the presence of hemodynamically significant coronary artery disease. The use of pacing stress echo to assess left ventricular contractile reserve is less established, but promising. Positive inotropic interventions are mirrored by smaller end-systolic volumes and higher end-systolic pressures. An increased heart rate progressively increases the force of ventricular contraction (Bowditch treppe or staircase phenomenon). To build the force-frequency relationship, the force is determined at different heart rate steps as the ratio of the systolic pressure (cuff sphygmomanometer)/end-systolic volume index (biplane Simpson rule). The heart rate is determined from ECG.ConclusionTwo-dimensional echocardiography during pacing is a useful tool in the detection of coronary artery disease. Because of its safety and ease of repeatability noninvasive pacing stress echo can be the first-line stress test in patients with permanent pacemaker.The force-frequency can be defined as up- sloping (normal) when the peak stress pacing systolic pressure/end-systolic volume index is higher than baseline and intermediate stress values, biphasic with an initial up- sloping followed by a later down-sloping trend, or flat or negative when peak stress pacing systolic pressure/end-systolic volume index is equal or lower than baseline stress values. This approach is certainly highly feasible and allows a conceptually immaculate definition of contractility with prognostic usefulness, but its therapeutic implications remains to be established. Bowditch treppe, assessed with pacing stress, can be used to assess the optimal stimulation frequency and to optimise the patient's chronotropic response in programming rate-adaptive pacemakers.

1155 Rapid atrial and ventricular pacing stress echocardiography in coronary artery disease: an alternative technique of stress testing

1155 Rapid atrial and ventricular pacing stress echocardiography in coronary artery disease: an alternative technique of stress testing

Long-term Prognostic Value of Transesophageal Atrial Pacing Stress Echocardiography

The aim of our study was to evaluate the long-term prognostic value of transesophageal atrial pacing stress echocardiography (TAPSE) for the prediction of cardiovascular events (myocardial infarction) and mortality at 10-year follow-up. TAPSE was applied as a diagnostic modality in 93 consecutive patients (mean age 45 +/- 8 years) who were diagnosed for the cause of chest pain. Long-term follow-up data were obtained from 87 (94%) patients with a mean duration of follow-up of 92 +/- 4 months. Stress echocardiography was performed using TAPSE with a mean pacing rate of 142 +/- 18/min. Predefined cardiac events occurred during the follow-up period in 45 (52%) patients, including 24 (28%) with hard end points: 10 (12%) with nonfatal myocardial infarction and 17 who died (events overlap). Positive result of TAPSE was found in 47 (54%) patients and among those with positive TAPSE result, 16 died (94% of total mortality) and 21 had a hard event (death or infarction-88% of total prevalence). Survival free from hard events was noted in 37 (92%) patients with negative TAPSE and only in 26 (55%) of those with positive TAPSE ( P = .001). Independent predictive factors for mortality were TAPSE positivity (relative risk with 95% confidence interval [RR/CI] = 39.6 [36.3-42.9], P = .0006) and diabetes (RR/CI = 10.2 [8.6-11.8], P = .0026). Independent predictive factors for myocardial infarction were diabetes (RR/CI = 8.1 [6.3-9.9], P = .0186) and significant coronary stenosis in angiography (RR/CI = 9.0 [6.8-11.2], P = .0479). Independent predictive factors for death or nonfatal myocardial infarction were TAPSE positivity (RR/CI = 12.3 [11.1-13.3], P = .0001) and diabetes (RR/CI = 7.0 [5.8-8.2], P = .0018). Positive TAPSE result carries long-term prognostic information regarding mortality and risk of myocardial infarction that can be used to identify patients requiring more aggressive treatment. Negative TAPSE allows highly accurate definition of low-risk population with discriminating power maintained during the 10-year period. TAPSE result and diabetes are the strongest independent predictors for long-term mortality in multivariate analysis.

802-5 Long-term prognostic value of pacing stress echocardiography compared with dipyridamole Tl201tomography in patients with permanent pacemaker and known or suspected coronary artery disease

802-5 Long-term prognostic value of pacing stress echocardiography compared with dipyridamole Tl201tomography in patients with permanent pacemaker and known or suspected coronary artery disease

P-215 Detection of coronary artery disease in patients with implanted permanent pacemakers: Comparison between rapid pacing stress echocardiography and radionuclide tomography

P-215 Detection of coronary artery disease in patients with implanted permanent pacemakers: Comparison between rapid pacing stress echocardiography and radionuclide tomography

704 Long-term prognostic value of pacing stress echocardiography compared with dipyridamole TI201 computed tomography in patients with permanent pacemaker and known or suspected coronary artery disease

704 Long-term prognostic value of pacing stress echocardiography compared with dipyridamole TI201 computed tomography in patients with permanent pacemaker and known or suspected coronary artery disease

Feasibility and safety of transeophageal atrial pacing stress echocardiography in patients with known or suspected coronary artery disease

To investigate the feasibility and safety of the transesophageal atrial pacing stress test combined with echocardiography (TAPSE) 1,727 TAPSE tests were performed on 1,641 patients consecutively referred to our echocardiographic laboratory for nonexercise stress testing (1,319 men; mean age 60 ± 9 years; 34% of whom were outpatients). Wall motion abnormalities were present at baseline echocardiography in 975 cases (56%). TAPSE was feasible in 1,648 cases (95.4%). It was not feasible in 79 patients due to failure of positioning the transnasal catheter (n = 11), the patient's intolerance of esophageal stimulation (n = 24), failure to obtain any or stable atrial capture (n = 36), or because the echocardiogram could not be evaluated at the peak of the test (n = 8). TAPSE was diagnostic in 1,584 cases (96% of the feasible tests, 92% of all attempts). TAPSE was nondiagnostic in 64 cases (4% of the feasible tests) due to second-degree atrioventricular type I block resistance to atropine administration with failure to achieve 85% of the age-predicted maximum heart rate (n = 59) or due to side effects, such as arrhythmias (n = 3) or hypertension (n = 2), which required premature interruption of the test. There were no major complications (death, myocardial infarction, or life-threatening arrhythmias). There were 28 instances of minor complications that comprised transient arrhythmias, including atrial fibrillation (n = 8), paroxysmal supraventricular tachycardia (n = 6), automatic atrial tachycardia (n = 1), sinus arrest (n = 1), atrioventricular junctional rhythm (n = 2), ectopic atrial rhythm (n = 2), nonsustained ventricular tachycardia (maximum 6 beats, n = 3), hypotension (n = 1), and hypertension (n = 4) leading to interruption of the test. Only 5 complications hampered a diagnostic result, whereas 18 occurred during or after a positive test and 5 during a negative, but diagnostic, test. Thus, TAPSE is a highly feasible and very safe stress test. It gives high percentage of diagnostic tests and may represent a valid alternative to pharmacologic stressors.

P-215 Detection of coronary artery disease in patients with implanted permanent pacemakers: Comparison between rapid pacing stress echocardiography and radionuclide tomography

P-215 Detection of coronary artery disease in patients with implanted permanent pacemakers: Comparison between rapid pacing stress echocardiography and radionuclide tomography