title: Pacemaker stress echocardiography predicts cardiac events in patients with permanent pacemaker.
abstract: OBJECTIVE
  Noninvasive pacemaker stress echocardiography is a newly introduced method for the diagnosis of coronary artery disease in patients with a permanent pacemaker. The prognostic value of pacemaker stress echocardiography has not been studied.
  
  
  METHODS
  We studied 136 patients (mean age 64+/-12 years) with a permanent pacemaker who underwent pacemaker stress echocardiography for evaluation of coronary artery disease. All patients underwent pacemaker stress echocardiography by external programming (pacing heart rate up to ischemia or target heart rate).
  
  
  RESULTS
  Thirty-one patients (23%) had normal study results. Ischemia was detected in 75 patients (55%). During a mean follow-up of 3.5+/-2.4 years, 35 deaths (26%) (20 the result of cardiac causes) and 2 nonfatal myocardial infarctions (1%) occurred. The annual cardiac death rate was 1.3% in patients without ischemia and 4.6% in patients with ischemia (P=.01). The annual all-cause mortality rate was 3.1% in patients without ischemia and 7% in patients with ischemia (P=.004). The presence of ischemia during pacemaker stress echocardiography was the strongest independent predictor of cardiac death (hazard ratio 4.1, confidence interval 1.2-14.5) and all-cause mortality (hazard ratio 2.7, confidence interval 1.2-6.0) in a multivariable model.
  
  
  CONCLUSIONS
  Myocardial ischemia during pacemaker stress echocardiography is an independent predictor of cardiac death and all-cause mortality in patients with a permanent pacemaker.
authors.affiliation: Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Elena
authors.initials: E
authors.lastname: Biagini
authors.forename: Arend F L
authors.initials: AF
authors.lastname: Schinkel
authors.forename: Abdou
authors.initials: A
authors.lastname: Elhendy
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Vittoria
authors.initials: V
authors.lastname: Rizzello
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: Boudewijn J
authors.initials: BJ
authors.lastname: Krenning
authors.forename: Olaf
authors.initials: O
authors.lastname: Schouten
authors.forename: Angelo
authors.initials: A
authors.lastname: Branzi
authors.forename: Guido
authors.initials: G
authors.lastname: Rocchi
authors.forename: Maarten L
authors.initials: ML
authors.lastname: Simoons
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000209:etiology; D016757:Death, Sudden, Cardiac; D025401:Echocardiography, Stress; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000209:etiology; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis*; D010138:Pacemaker, Artificial; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors