title: Stress echocardiography in octogenarians: transesophageal atrial pacing is accurate, safe, and well tolerated.
abstract: The feasibility and diagnostic accuracy of transesophageal pacing stress echocardiography for detection of inducible myocardial ischemia were evaluated in 161 patients 80 years of age or older (mean 84 +/- 3.9, range 80-97). The pacing time was 5.5 +/- 2.5 minutes with a total test time of 37 +/- 7 minutes. The mean achieved heart rate was 96 +/- 7% (83%-121%) of maximum predicted with an average rate pressure product of 21,560 +/- 5175 beats/min x mm Hg. There were minor adverse events in 8% of cases and no major complications occurred. Patient acceptance was high. When compared with myocardial single photon emission computed tomography, pacing stress echocardiography had a sensitivity of 89% and a specificity of 93% for the detection of myocardial ischemia, and 91% agreement (kappa = 0.80, P < .001). We demonstrate that pacing stress echocardiography is safe and accurate for detection of myocardial ischemia and, thus, a reliable substitute to exercise and pharmacologic stress testing in octogenarians.
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
authors.forename: Sergio L
authors.initials: SL
authors.lastname: Kobal
authors.forename: Charles
authors.initials: C
authors.lastname: Pollick
authors.forename: Shaul
authors.initials: S
authors.lastname: Atar
authors.forename: Takashi
authors.initials: T
authors.lastname: Miyamoto
authors.forename: Noune
authors.initials: N
authors.lastname: Aslanian
authors.forename: Yoram
authors.initials: Y
authors.lastname: Neuman
authors.forename: Kirsten
authors.initials: K
authors.lastname: Tolstrup
authors.forename: Tasneem Z
authors.initials: TZ
authors.lastname: Naqvi
authors.forename: Huai
authors.initials: H
authors.lastname: Luo
authors.forename: Bruce
authors.initials: B
authors.lastname: Macrum
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Siegel
mesh_terms: D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial / Q000706:statistics & numerical data*; D025401:Echocardiography, Stress / Q000379:methods* / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D005260:Female; D015577:Geriatric Assessment / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity