title: Ischemia induced by transesophageal atrial pacing stress echocardiography predicts long-term mortality.
abstract: 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.
authors: Department of Biomedical and Surgical Sciences, Section of Cardiology, University of Verona, Verona, Italy. maurizio.anselmi@univr.it
authors: Maurizio
authors: M
authors: Anselmi
authors: Mara
authors: M
authors: Pilati
authors: Giorgio
authors: G
authors: Golia
authors: Pierfrancesco
authors: P
authors: Agostoni
authors: Silvia
authors: S
authors: Quintarelli
authors: Lucia
authors: L
authors: Rossetti
authors: Corrado
authors: C
authors: Vassanelli
mesh_terms: 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