Pacemaker stress echocardiography predicts cardiac events in patients with permanent pacemaker.
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.
Biagini
Elena
E
Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
Schinkel
Arend F L
AF
Elhendy
Abdou
A
Bax
Jeroen J
JJ
Rizzello
Vittoria
V
van Domburg
Ron T
RT
Krenning
Boudewijn J
BJ
Schouten
Olaf
O
Branzi
Angelo
A
Rocchi
Guido
G
Simoons
Maarten L
ML
Poldermans
Don
D
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