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CLINICAL STUDY

A rapid stress-testing protocol for the detection of coronary artery disease

Comparison of two-stage transesophageal atrial pacing stress echocardiography with dobutamine stress echocardiography

Andrew J. Rainbird, MBBS, FRACP^*, Patricia A. Pellikka, MD, FACC^*, Vicky L. Stussy, RN^*, Douglas M. Mahoney, MS and James B. Seward, MD, FACC^*

^* Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA
Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA

Manuscript received December 27, 1999; revised manuscript received April 24, 2000, accepted June 21, 2000.

Reprint requests and correspondence to: Dr. Patricia A. Pellikka, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905

OBJECTIVES

We compared a new two-stage transesophageal atrial pacing stress echocardiography (TAPSE) protocol with a standard dobutamine stress echocardiography (DSE) protocol.

BACKGROUND

Transesophageal atrial pacing stress echocardiography has been proposed as an efficient alternative to DSE.

METHODS

Two-stage TAPSE (85% and 100% of age-predicted maximum heart rate) and DSE (5 to 40 µg/kg/min at 3-min stages with or without atropine) were both performed, in random sequence, in each patient of a study group of 36 patients. Regional wall-motion analysis, patient acceptance (1 = low, 5 = high), hemodynamics and duration for performing and interpreting tests were compared.

RESULTS

Transesophageal atrial pacing stress echocardiography was successful in 35 of the 36 patients (feasibility 97%). More TAPSE than DSE studies were called "ischemic" (37% vs. 14%; p = 0.005). Peak heart rate was higher with TAPSE (144 ± 18 vs. 129 ± 15 beats/min, p = 0.0001). Peak cardiac index (4.6 ± 2.1 vs. 5.1 ± 1.9 liters/min/m², p = 0.14), patient acceptance score (4.2 ± 0.7 vs. 3.8 ± 1.3, p = 0.17) and study duration (14.2 ± 9.3 vs. 13.3 ± 3.3 min, p = 0.59) were similar. Recovery time (7.1 ± 7.6 vs. 16.2 ± 15.9 min, p = 0.0003) and interpretation time (9.1 ± 2.8 vs. 13.5 ± 4.4 min, p = 0.0001) were shorter for TAPSE than for DSE.

CONCLUSIONS

Two-stage TAPSE permits rapid evaluation of cardiac patients. Peak cardiac index and patient acceptance scores were similar for TAPSE and DSE. Ischemia was detected more often with TAPSE; this result was attributed to the higher peak heart rate obtained with this protocol.

Abbreviations and Acronyms   BP = blood pressure   CAD = coronary artery disease   DSE = dobutamine stress echocardiography   ECG = electrocardiogram   TAPSE = transesophageal atrial pacing stress echocardiography