Comparison of postexercise and transesophageal atrial pacing two-dimensional echocardiography for detection of coronary artery disease.
Two-dimensional (2-D) echocardiography during transesophageal atrial pacing (TAP) was recently proposed as an alternative to exercise 2-D echocardiography for the diagnosis of coronary artery disease (CAD). To compare these 2 methods, 78 consecutive patients with good-quality echocardiographic (echo) examinations at rest were studied. Two-dimensional echocardiography was performed immediately after supine bicycle exercise and at peak atrial pacing obtained with transesophageal atrial stimulation. Twenty patients were excluded: 16 because of poor quality of 2-D echo images after exercise and 4 because of inadequate TAP studies (atrial capture not achieved in 2 and intolerance in 2). Of the remaining 58 patients, 39 had significant CAD (at least 75% diameter stenosis of at least 1 major coronary artery) and 19 had no significant CAD. The 2 test responses were considered positive if a wall motion abnormality was detected during pacing or after exercise. Sensitivity and specificity were 82% and 95% after exercise and 90% and 84% during TAP. In patients with significant CAD but without wall motion abnormalities at rest, sensitivity was 75% during pacing and 56% after exercise. In patients with significant CAD, the wall motion score index decreased significantly with both types of stress; during pacing wall motion score index was significantly lower than after exercise. Thus, 2-D echo during TAP appears to be a feasible and reliable alternative to postexercise echo for the detection of CAD.
D001794:Blood Pressure; D006328:Cardiac Catheterization; D003327:Coronary Disease / Q000175:diagnosis*; D004452:Echocardiography / Q000379:methods*; D004947:Esophagus; D005080:Exercise Test; D006339:Heart Rate; D006801:Humans; D008875:Middle Aged