Detection of left ventricular ischemia during atrial pacing: simultaneous assessment by echocardiography and invasive hemodynamic measurements

Summary:The purpose of this study was to determine the diagnostic value of quantitative two-dimensional echocardiography during transesophageal atrial pacing in assessing the presence and severity of coronary artery disease. Apical four-and two-chamber views were registered at rest and at different pacing rates. Computerized quantitative evaluation of left ventricle wall motion was performed. On the basis of left ventricle wall motion analysis data of 22 individuals with no coronary pathology, as assessed by angiography and with negative exercise ECG and transesophageal atrial pacing ECG test, nomograms for assessment of wall motion abnormalities and for calculation of asynergy area as a measure of wall motion abnormality extent were obtained. The method revealed new transient wall motion abnormalities during pacing or exacerbation of old ones present at rest in 83 of the 89 patients with angiographically proven coronary artery stenosis 2 70% and in 3 of the 32 controls with no changes in their coronary angiograms. Thus, it showed high sensitivity (93%), specificity (91 %), predictive value of positive result (96%), predictive value of negative result (83%). and cfliciency of the test (93%). These values appeared t o be higher than those calculated for transesophagcal atrial pacing ECG, recorded simultaneously with echocardiographic images (81, 87, 95, 62, and 83%, respectively) and for exercise ECG test which was performed in 66 coronary patients and in 29 controls (68, 86, 92, 54, and 74%, respectively). The extent of pacinginduced left ventricular regional wall motion abnormalities appeared to be directly correlated to the extent of coronary artery disease. Thus, transesophageal atrial pacing two-dimensional echo stress testing seems to be a valuable method for the evaluation of coronary artery disease and for the assessment of its extent.

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Quantitative assessment of transient left ventricular asynergy in coronary artery disease

Laucevi

Beruk

Kosinskas

et al. 1991

Clinical Cardiology

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Simultaneous transesophageal atrial pacing and transesophageal two-dimensional echocardiography: A new method of stress echocardiography

Lambertz

Kreis

Trümper

et al. 1990

Journal of the American College of Cardiology

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The diagnostic use of exercise echocardiography has been widely reported. However, transthoracic exercise echocardiography is inadequate in up to 20% of patients because of poor image quality related to exercise. In an attempt to overcome these limitations, a system was developed in which transesophageal echocardiography is combined with simultaneous transesophageal atrial pacing by means of the same probe. In a prospective study, transesophageal echocardiography was performed before, during and immediately after maximal atrial pacing in 50 patients with suspected coronary artery disease. Results of transesophageal stress echocardiography were considered abnormal when new pacing-induced regional wall motion abnormalities were observed. Correlative routine bicycle exercise testing was carried out in 44 patients. Cardiac catheterization was performed in all patients. The success rate in obtaining high quality diagnostic images was 100% by transesophageal echocardiography. All nine patients without angiographic evidence of coronary artery disease had a normal result on the transesophageal stress echocardiogram (100% specificity). Thirty-eight of 41 patients with coronary artery disease (defined as greater than or equal to 50% luminal diameter narrowing of at least one major vessel) had an abnormal result on the transesophageal stress echocardiogram (93% sensitivity). The sensitivity of the technique for one, two or three vessel disease was 85%, 100% and 100%, respectively, compared with 44%, 50% and 83%, respectively, for bicycle exercise testing; the 12 lead electrocardiogram (ECG) during rapid atrial pacing showed a sensitivity of 25%, 64% and 86%, respectively. Thus, rapid atrial pacing combined with simultaneous transesophageal echocardiography is a highly specific and sensitive technique for the detection of coronary artery disease. Ischemia-induced wall motion abnormalities were detected earlier than observed ECG changes. The technique appears to be particularly suited to patients who are unable to perform an active stress test or those with poor quality transthoracic echocardiograms.

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Detection of left ventricular ischemia during atrial pacing: simultaneous assessment by echocardiography and invasive hemodynamic measurements

Cited by 2 publications

References 27 publications

Quantitative assessment of transient left ventricular asynergy in coronary artery disease

Quantitative assessment of transient left ventricular asynergy in coronary artery disease

Simultaneous transesophageal atrial pacing and transesophageal two-dimensional echocardiography: A new method of stress echocardiography

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