title: Accuracy and long-term prognostic value of pacing stress echocardiography compared with dipyridamole tl201 emission computed tomography in patients with a permanent pacemaker and known or suspected coronary artery disease.
abstract: OBJECTIVE
  Myocardial ischemia is difficult to assess by noninvasive methods in patients with a permanent pacemaker. Pacing stress echocardiography (PASE) has been used successfully in the detection of coronary artery disease (CAD). However, there are no data comparing PASE and other methods.
  
  
  METHODS
  We compared agreement and accuracy of PASE and radionuclide tomography (SPECT) in detecting CAD in 58 patients, mean age 75 +/- 7 years, with a permanent pacemaker and known or suspected CAD. Thirty-nine patients underwent coronary angiography. The prognostic value of these tests was determined by prediction of cardiac events and cardiac death.
  
  
  RESULTS
  PASE and SPECT were positive in 39 and 43 patients, respectively. The agreement between the tests was 75%; kappa value 0.64. The sensitivity was 87 and 96% and the specificity 78 and 57%, respectively. With median follow-up of 51 months, there were 24 cardiac events and 8 cardiac deaths. Multivariable analysis determined that positive PASE was the only independent predictive factor associated with cardiac events and cardiac death.
  
  
  CONCLUSIONS
  PASE is a feasible and effective method for detection of significant CAD in patients with permanent-pacemaker and allows effective risk stratification. PASE merits further study in larger prospective comparative studies.
authors.affiliation: The Heart Institute, Kaplan Medical Center, Rehovot, Affiliated to the Hebrew University and Hadassah Medical School, Jerusalem, Israel. sara_s@clalit.org.il
authors.forename: Sara
authors.initials: S
authors.lastname: Shimoni
authors.forename: Sorel
authors.initials: S
authors.lastname: Goland
authors.forename: Shay
authors.initials: S
authors.lastname: Livshitz
authors.forename: Alexander
authors.initials: A
authors.lastname: Arditi
authors.forename: Oded
authors.initials: O
authors.lastname: Ayzenber
authors.forename: Fabio
authors.initials: F
authors.lastname: Kusniec
authors.forename: Gera
authors.initials: G
authors.lastname: Gendelman
authors.forename: Orly
authors.initials: O
authors.lastname: Edri
authors.forename: Gabi
authors.initials: G
authors.lastname: Lutati
authors.forename: Rosa
authors.initials: R
authors.lastname: Levi
authors.forename: Avraham
authors.initials: A
authors.lastname: Caspi
authors.forename: Menashe
authors.initials: M
authors.lastname: Epstein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000401:mortality; D004176:Dipyridamole / Q000008:administration & dosage; D025401:Echocardiography, Stress / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D007557:Israel / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000175:diagnosis; D010138:Pacemaker, Artificial; D011379:Prognosis; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods / Q000592:standards*; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014665:Vasodilator Agents; D004176:Dipyridamole