title: A novel finding to assess ischemia in pacing stress echocardiography (PASE).
abstract: BACKGROUND
  Normalization of heart rate post-pacing stress echocardiography (PASE) could enable evaluation of effect of ischemia on diastolic function.
  
  
  METHODS
  We examined the effect of pacing on left ventricular (LV) filling in 55 patients who underwent a transesophageal PASE. Pulse wave Doppler of mitral inflow was obtained at baseline and during transition from peak pacing to up to three beats immediate post pacing.
  
  
  RESULTS
  Thirty-four patients (62%; 62 +/- 12 years) had normal (NL) PASE, wall motion score index (WMSI) 1 +/- 0 at baseline and during PASE. Sixteen patients (29%; 64 +/- 12 years) had ischemic (ISCH) PASE, WMSI 1.07 +/- 0.08 at baseline and 1.40 +/- 0.21 during PASE. Five patients (9%; 81 +/- 5 years) had abnormal (ABN) PASE, WMSI 1.55 +/- 0.34 at baseline and 1.55 +/- 0.34 during PASE. The ABN group had the most pronounced decrease in deceleration time (DT) seen in all three post-PASE beats (221 +/- 29 ms at baseline vs. 145 +/- 46, 144 +/- 26 and 144 +/- 18 ms at beats 1, 2, and 3, P < 0.005 from baseline for all). The DT reduced significantly at post-PASE beat 1 from baseline (234 +/- 45 ms vs. 158 +/- 36 ms, P = 0.02) in the ISCH group, whereas no significant change in DT occurred in the NL group (239 +/- 74 ms vs. 222 +/- 58 ms, P = 0.14) at beat 1.
  
  
  CONCLUSIONS
  In ISCH and ABN ventricles the duration of early diastolic filling decreased post-pacing. This new finding of a shortened deceleration time (DT) may be a marker of an ischemic response in PASE reflecting abnormal LV compliance.
authors.affiliation: Cardiac Non-Invasive Laboratory, Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA. tasneem.naqvi@cshs.org
authors.forename: Tasneem Z
authors.initials: TZ
authors.lastname: Naqvi
authors.forename: Noune G
authors.initials: NG
authors.lastname: Aslanian
authors.forename: Asim M
authors.initials: AM
authors.lastname: Rafique
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Siegel
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis; D003971:Diastole; D015150:Echocardiography, Doppler / Q000379:methods; D025401:Echocardiography, Stress / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000503:physiopathology; D011237:Predictive Value of Tests; D013997:Time Factors; D016277:Ventricular Function, Left