Ischemia induced by transesophageal atrial pacing stress echocardiography predicts long-term mortality.
OBJECTIVE
It was the aim of this study to investigate the long-term value of transesophageal atrial pacing in predicting death in patients with known or suspected coronary artery disease.


BACKGROUND
Exercise, dobutamine and dipyridamole stress echocardiography are all effective in predicting cardiac death. Transesophageal atrial pacing stress echocardiography (TAPSE) is a safe alternative to pharmacologic tests, but no information is available on prognosis with TAPSE.


METHODS
One thousand and ten TAPSE were performed in 975 consecutive patients. TAPSE was feasible in 970 tests (96%); after exclusion of the 35 patients with more than 1 TAPSE and those 42 lost at follow-up (mean 4.5 +/- 3.7 years, median 6 years), the final population consisted of 857 patients (675 males, 58 +/- 9 years old). The Cox model was used to analyze the association of clinical, resting and TAPSE variables with cardiac death.


RESULTS
TAPSE was abnormal in 281 (32%) patients. There were 46 cardiac-related deaths (5%), 25 among the 281 patients with an abnormal test (8.9%) and 21 among the 576 patients with a normal test (3.6%). The predictors of cardiac death were age, previous revascularization, resting wall motion score index and its variation during TAPSE. Abnormal TAPSE significantly increases the value of models predicting cardiac death. Moreover, cardiac mortality increased progressively with the extent of the induced ischemia.


CONCLUSIONS
TAPSE is a useful tool in predicting death in patients with known or suspected coronary artery disease and might be considered an alternative to pharmacologic stressors.
Anselmi
Maurizio
M
Department of Biomedical and Surgical Sciences, Section of Cardiology, University of Verona, Verona, Italy. maurizio.anselmi@univr.it
Pilati
Mara
M
Golia
Giorgio
G
Agostoni
Pierfrancesco
P
Quintarelli
Silvia
S
Rossetti
Lucia
L
Vassanelli
Corrado
C
D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D016757:Death, Sudden, Cardiac; D025401:Echocardiography, Stress / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D009204:Myocardial Revascularization / Q000379:methods / Q000401:mortality; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis