title: Atrial pacing stress echocardiography: an alternative diagnostic test for chest pain in the elderly.
abstract: The authors utilized rapid right atrial pacing and handgrip exercise to provoke myocardial ischemia in 20 participants (age >65 years) who, for reasons of disability, were not candidates for exercise and pharmacologic stress testing. Echocardiographic left ventricular ejection fraction and left ventricular wall motions were obtained during pacing at baseline and at maximal pacing rates and were compared with coronary angiography. Using the failure of left ventricular ejection fraction to increase with pacing as an indicator of myocardial ischemia, the test yielded a sensitivity of 75%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 71%. When a pacing-induced decrease of wall-motion index was taken as an ischemia indicator, the sensitivity was 63%, specificity 100%, positive predictive value 100%, and negative predictive value 80%. Rapid atrial pacing echocardiography is a safe test. It may be considered in a select group of elderly patients as an alternative to exercise or pharmacologic tests before resorting to coronary angiography.
authors.affiliation: Division of Cardiology, College of Medicine, State University of New York Health Science Center at Brooklyn, Brooklyn, NY 11235, USA.
authors.forename: Mohandas M
authors.initials: MM
authors.lastname: Shenoy
authors.forename: Ranjita
authors.initials: R
authors.lastname: Sengupta
authors.forename: Ashok
authors.initials: A
authors.lastname: Khanna
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002637:Chest Pain / Q000175:diagnosis*; D015331:Cohort Studies; D025401:Echocardiography, Stress / Q000379:methods*; D004562:Electrocardiography / Q000379:methods; D005080:Exercise Test / Q000379:methods*; D005260:Female; D015577:Geriatric Assessment; D006334:Heart Function Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013793:Thallium
chemical_list: D013793:Thallium