This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Picano, E. Articles by De Nes, M. Search for Related Content PubMed PubMed Citation Articles by Picano, E. Articles by De Nes, M.

CLINICAL STUDY

Noninvasive pacemaker stress echocardiography for diagnosis of coronary artery disease

A multicenter study

Eugenio Picano, MD, PhD^*,*, Annalisa Alaimo, MD, Vlad Chubuchny, MD, Edyta Plonska, MD, Vittorio Baldo, MD^||, Umberto Baldini, MD^**, Marina Pauletti, MD^**, Roberto Perticucci, MD, Lucas Fonseca, MD, Hector Ricardo Villarraga, MD, Carlo Emanuelli, MD^¶, Gennaro Miracapillo, MD^||||, Enrico Hoffmann, MD^* and Maurizio De Nes, MedTech^*

^* Institute of Clinical Physiology, Pisa, Italy
Cardiology Division, Palermo Hospital, Palermo, Italy
Ukrainian Institute of Cardiology, Kiev, Ukraine
Cardiology Division, Szecyn Hospital, Szecyn, Poland
^|| Cardiology Division, Rome, Italy
^¶ Cardiology Division, Cremona, Italy
^** Cardiology Division, Livorno Hospital, Livorno, Italy
Cardiology Division, Arezzo Hospital, Arezzo, Italy
Cardiology Division, Santa Luzia Hospital, Brazilia, Brazil
Cardiology Division, Fundacion Valle del Lili Cali, Cali, Colombia
^|||| Cardiology Unit, Grosseto Hospital, Grosseto, Italy

Manuscript received December 21, 2001; revised manuscript received May 2, 2002, accepted June 27, 2002.

^* Reprint requests and correspondence: Dr. Eugenio Picano, Institute of Clinical Physiology, Via Moruzzi, 1 56126 Pisa, Italy.
picano{at}ifc.cnr.it

OBJECTIVES: We evaluated the feasibility, safety, and diagnostic accuracy of noninvasive pacemaker stress echocardiography (PASE) test as a potential alternative to exercise or pharmacologic stress in patients with suspected or known coronary artery disease (CAD).

BACKGROUND: Transesophageal atrial pacing echocardiography is an accurate test for detection of CAD, but its practical impact has been blunted by semi-invasiveness. In the expanding population of patients with permanent pacemakers (PMs), a pacing stress test can be administered noninvasively by external programming of the PM.

METHODS: In a prospective, multicenter, international study design, transthoracic stress-pacing echocardiography was performed in 46 consecutive patients with a permanent PM (33 men, 13 women; age 66.6 ± 11.1 years) with suspected or known CAD. All patients underwent noninvasive PM-stress test by external programming (10 beats/min increments up to ischemia or target heart rate). Coronary angiography was performed in all patients independently of test results. Significant CAD was defined as 50% visually assessed diameter reduction in at least one major epicardial coronary artery. All coronary angiograms were scored by Duke prognostic weight values.

RESULTS: Fifteen patients were stimulated in atrial, and the remaining 31 in ventricular mode during stress. No significant side effects were observed. Echocardiographic images were interpretable in all patients. The average duration of stress was 8.9 ± 3.5 min. Significant CAD was found in 27 patients. Sensitivity of PASE for identifying patients with significant CAD was 70%, specificity was 90%, and accuracy was 78%. When any abnormal wall motion at rest that remained unchanged at peak stress was regarded as a positive result of PASE, then the sensitivity, specificity, and accuracy levels for identifying patients with significant CAD were 85%, 84%, and 85%, respectively. Four of the eight patients with a false negative did not reach the target heart rate. The Duke values had significant correlation with values of wall motion score index at peak stress (r = 0.67) and with peak heart rate (r = –0.3).

CONCLUSIONS: Noninvasive PASE is a simple, rapid, safe, and diagnostically efficient option for patients with permanent PM and suspected or known CAD.

Abbreviations and Acronyms   CAD   coronary artery disease   CI   confidence interval   ECG   electrocardiogram   IV   intravenous   PASE   pacemaker stress echocardiography   PM   pacemaker   2D   two-dimensional

This article has been cited by other articles:

				R. Sicari, P. Nihoyannopoulos, A. Evangelista, J. Kasprzak, P. Lancellotti, D. Poldermans, J.-U. Voigt, J. L. Zamorano, and on behalf of the European Association of Echocardi Stress echocardiography expert consensus statement: European Association of Echocardiography (EAE) (a registered branch of the ESC) Eur J Echocardiogr, July 1, 2008; 9(4): 415 - 437. [Abstract] [Full Text] [PDF]

				Prof. P. E. Vardas and E. I. Skalidis Specificity of noninvasive pacemaker stress echocardiography in diagnosis of coronary artery disease J. Am. Coll. Cardiol., March 19, 2003; 41(6): 1068 - 1069. [Full Text] [PDF]