title: Transthoracic stress echocardiography with transesophageal atrial pacing for bedside evaluation of inducible myocardial ischemia in patients with new-onset chest pain.
abstract: To date, there are no data on the feasibility and accuracy of bedside pacing stress echocardiography in patients admitted to the hospital with new-onset chest pain or unstable angina. We evaluated the feasibility of pacing stress echocardiography and examined its correlation with myocardial perfusion stress scintigraphy (rest thallium-201/stress technetium-99m sestamibi dual-isotope myocardial perfusion single-photon emission computerized tomography) performed within 24 hours of the pacing stress echocardiography test. We studied 70 consecutive patients after acute myocardial infarction had been excluded. The bedside pacing stress echocardiography test was performed with 10Fr transesophageal pacing catheters. We found pacing stress echocardiography to be feasible and safe (3% minor adverse event rate) at the patients' bedside. Target heart rate of >85% of the age-predicted heart rate was achieved in 96% of patients, and the mean rate-pressure product was 22,644 +/- 4,520 beats/min/mm Hg. The mean duration of the bedside pacing stress echocardiography test including technical preparations and image interpretation was 41 +/- 7 minutes. Pacing stress echocardiography and myocardial perfusion stress scintigraphy correlated well for identification or exclusion of inducible myocardial ischemia in 63 of 70 patients (90%) (kappa 0.81, p <0.001). The extent of inducible myocardial ischemia by vascular territories correlated with myocardial perfusion stress scintigraphy in 52 of 70 patients (74%) (kappa 0.6, p <0.001). We conclude that bedside pacing stress echocardiography is feasible and safe, and highly correlates with myocardial perfusion stress scintigraphy for identifying inducible myocardial ischemia in patients with new onset of chest pain or unstable angina.
authors.affiliation: Department of Medicine (Division of Cardiology), Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
authors.forename: S
authors.initials: S
authors.lastname: Atar
authors.forename: B
authors.initials: B
authors.lastname: Cercek
authors.forename: T
authors.initials: T
authors.lastname: Nagai
authors.forename: H
authors.initials: H
authors.lastname: Luo
authors.forename: H C
authors.initials: HC
authors.lastname: Lewin
authors.forename: T Z
authors.initials: TZ
authors.lastname: Naqvi
authors.forename: R J
authors.initials: RJ
authors.lastname: Siegel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000150:complications / Q000175:diagnosis*; D002304:Cardiac Pacing, Artificial; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology; D017023:Coronary Angiography; D003937:Diagnosis, Differential; D004452:Echocardiography / Q000379:methods*; D004562:Electrocardiography; D004947:Esophagus; D005080:Exercise Test; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D015203:Reproducibility of Results; D015899:Tomography, Emission-Computed, Single-Photon