Stress echocardiography in octogenarians: transesophageal atrial pacing is accurate, safe, and well tolerated.
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.
Kobal
Sergio L
SL
Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
Pollick
Charles
C
Atar
Shaul
S
Miyamoto
Takashi
T
Aslanian
Noune
N
Neuman
Yoram
Y
Tolstrup
Kirsten
K
Naqvi
Tasneem Z
TZ
Luo
Huai
H
Macrum
Bruce
B
Siegel
Robert J
RJ
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