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.
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.
Shimoni
Sara
S
The Heart Institute, Kaplan Medical Center, Rehovot, Affiliated to the Hebrew University and Hadassah Medical School, Jerusalem, Israel. sara_s@clalit.org.il
Goland
Sorel
S
Livshitz
Shay
S
Arditi
Alexander
A
Ayzenber
Oded
O
Kusniec
Fabio
F
Gendelman
Gera
G
Edri
Orly
O
Lutati
Gabi
G
Levi
Rosa
R
Caspi
Avraham
A
Epstein
Menashe
M
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
D014665:Vasodilator Agents; D004176:Dipyridamole