title: Influence of gender on diagnostic accuracy of rapid atrial and ventricular pacing stress echocardiography for the detection of coronary artery disease: a multicenter study (Pol-RAPSE final results).
abstract: BACKGROUND
  Rapid cardiac pacing using a permanent pacemaker may be used as a nonpharmacologic stress during echocardiographic imaging for diagnosing coronary artery disease (CAD). We presented the final results of a national multicenter study, the Polish study on Rapid Pacing Stress Echocardiography (Pol-RAPSE), aimed at the assessment of the safety and accuracy of rapid cardiac pacing for the noninvasive diagnosis of CAD in women and men.
  
  
  METHODS
  We have analyzed 149 tests performed in 100 patients with permanent pacemakers (27% ventricular pacing [VVI], 10% atrial pacing [AAI], 63% dual chamber pacing [DDD]) referred for stress echocardiography. All patients underwent coronary angiography as a reference for assessing the accuracy of rapid cardiac pacing stress echocardiography (RAPSE). Significant CAD was defined as luminal diameter reduction more than 50% in at least 1 major epicardial coronary artery.
  
  
  RESULTS
  Peak stress was obtained in 73 patients using physiologic stimulation of right atrium by and mode or in 76 patients by VVI mode. Significant CAD was detected by angiography in 46% of women and 57% of men (P = not significant). The feasibility of the test was 98%. Overall accuracy of the test was slightly lower in women than in men (75% vs 88%, P = .04), although there were no significant differences in sensitivity, specificity, and positive and negative predictive values between the genders. In women (n = 48), the accuracy of RAPSE performed in AAI and VVI mode was 79% and 70% with no significant difference and in men was 89% and 87%, respectively (P = not significant).
  
  
  CONCLUSIONS
  RAPSE is a safe and feasible modality for diagnosing CAD. The method offers slightly higher accuracy in men compared with women. Overall efficacy is satisfactory with both AAI and VVI pacing, although easier interpretation of peak AAI/DDD images results in a trend toward better accuracy.
authors.affiliation: Pomeranian Medical University Szczecin, Szczecin, Poland.
authors.forename: Edyta
authors.initials: E
authors.lastname: Płońska-Gosciniak
authors.forename: Patrizio
authors.initials: P
authors.lastname: Lancellotti
authors.forename: Andrzej
authors.initials: A
authors.lastname: Kleinrok
authors.forename: Andrzej
authors.initials: A
authors.lastname: Gackowski
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Gasior
authors.forename: Ilona
authors.initials: I
authors.lastname: Kowalik
authors.forename: Anna
authors.initials: A
authors.lastname: Gozdzik
authors.forename: Jarosław D
authors.initials: JD
authors.lastname: Kasprzak
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D004452:Echocardiography / Q000706:statistics & numerical data*; D005080:Exercise Test / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D011044:Poland / Q000453:epidemiology; D015995:Prevalence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017678:Sex Distribution