A rapid stress-testing protocol for the detection of coronary artery disease: comparison of two-stage transesophageal atrial pacing stress echocardiography with dobutamine stress echocardiography.
OBJECTIVE
We compared a new two-stage transesophageal atrial pacing stress echocardiography (TAPSE) protocol with a standard dobutamine stress echocardiography (DSE) protocol.


BACKGROUND
Transesophageal atrial pacing stress echocardiography has been proposed as an efficient alternative to DSE.


METHODS
Two-stage TAPSE (85% and 100% of age-predicted maximum heart rate) and DSE (5 to 40 microg/kg/min at 3-min stages with or without atropine) were both performed, in random sequence, in each patient of a study group of 36 patients. Regional wall-motion analysis, patient acceptance (1 = low, 5 = high), hemodynamics and duration for performing and interpreting tests were compared.


RESULTS
Transesophageal atrial pacing stress echocardiography was successful in 35 of the 36 patients (feasibility 97%). More TAPSE than DSE studies were called "ischemic" (37% vs. 14%; p = 0.005). Peak heart rate was higher with TAPSE (144 +/- 18 vs. 129 +/- 15 beats/min, p = 0.0001). Peak cardiac index (4.6 +/- 2.1 vs. 5.1 +/- 1.9 liters/min/m2, p = 0.14), patient acceptance score (4.2 +/- 0.7 vs. 3.8 +/- 1.3, p = 0.17) and study duration (14.2 +/- 9.3 vs. 13.3 +/- 3.3 min, p = 0.59) were similar. Recovery time (7.1 +/- 7.6 vs. 16.2 +/- 15.9 min, p = 0.0003) and interpretation time (9.1 +/- 2.8 vs. 13.5 +/- 4.4 min, p = 0.0001) were shorter for TAPSE than for DSE.


CONCLUSIONS
Two-stage TAPSE permits rapid evaluation of cardiac patients. Peak cardiac index and patient acceptance scores were similar for TAPSE and DSE. Ischemia was detected more often with TAPSE; this result was attributed to the higher peak heart rate obtained with this protocol.
Rainbird
A J
AJ
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Pellikka
P A
PA
Stussy
V L
VL
Mahoney
D M
DM
Seward
J B
JB
D000368:Aged; D002316:Cardiotonic Agents; D002985:Clinical Protocols; D003327:Coronary Disease / Q000175:diagnosis* / Q000503:physiopathology; D004280:Dobutamine; D017548:Echocardiography, Transesophageal; D005080:Exercise Test / Q000379:methods; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006801:Humans; D008297:Male; D013997:Time Factors
D002316:Cardiotonic Agents; D004280:Dobutamine