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CLINICAL STUDY: STRESS TESTING

Pacing stress echocardiography: an alternative to pharmacologic stress testing

^a Department of Medicine, Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA

Manuscript received February 2, 2000; revised manuscript received May 16, 2000, accepted July 12, 2000.

Reprint requests and correspondence: Dr. Robert J. Siegel, Cardiac Noninvasive Laboratory, Room #5335, Cedars-Sinai Medical Center, Los Angeles, California 90048
siegel{at}cshs.org

OBJECTIVES

We sought to evaluate the diagnostic accuracy and feasibility of bedside pacing stress echocardiography (PASE) as a potential substitute for pharmacologic stress echocardiography in patients admitted to the hospital with new-onset chest pain or worsening angina pectoris.

BACKGROUND

Accurate and rapid noninvasive identification and evaluation of the extent of coronary artery disease (CAD) is essential for optimal management of these patients.

METHODS

Bedside transthoracic stress echocardiography was performed in 54 consecutive patients admitted to a community hospital with new-onset chest pain, after acute myocardial infarction had been excluded. We used 10F transesophageal pacing catheters and a rapid and modified pacing protocol. The PASE results were validated in all patients by coronary angiography performed within 24 h of the test. Significant CAD was defined as 75% stenosis in at least one major epicardial coronary artery.

RESULTS

The sensitivity of PASE for identifying patients with significant CAD was 95%, specificity was 87% and accuracy was 92%. The extent of significant CAD (single- or multivessel disease) was highly concordant with coronary angiography (kappa = 0.73, p < 0.001). Pacing stress echocardiography was well tolerated, and only 4% of the patients had minor adverse events. The mean rate–pressure product at peak pacing was 22,313 ± 5,357 beats/min per mm Hg, and heart rate >85% of the age-predicted target was achieved in 94% of patients. The average duration of the bedside PASE test, including image interpretation, was 38 ± 6 min.

CONCLUSIONS

Bedside PASE is rapid, tolerable and accurate for identification of significant CAD in patients admitted to the hospital with new-onset chest pain or worsening angina pectoris.

Abbreviations and Acronyms   CAD = coronary artery disease   DSE = dobutamine stress echocardiography   ECG = electrocardiography   PASE = pacing stress echocardiography   SPECT = single-photon emission computed tomography

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