Transthoracic stress echocardiography with transesophageal atrial pacing for bedside evaluation of inducible myocardial ischemia in patients with new-onset chest pain

To date, there are no data on the feasibility and accuracy of bedside pacin g stress echocardiography in patients admitted to the hospital with new-ons et chest pain or unstable angina. We evaluated the feasibility of pacing st ress echocardiography and examined its correlation with myocardial perfusio n stress scintigraphy (rest thallium-201/stress technetium-99m sestamibi du al-isotope myocardial perfusion single-photon emission computerized tomogra phy) performed within 24 hours of the pacing stress echocardiography test. We studied 70 consecutive patients after acute myocardial infarction had be en excluded. The bedside pacing stress echocardiography test was performed with 10Fr transesophageal pacing catheters, We found pacing stress echocard iography to be feasible and safe (3% minor adverse event rate) at the patie nts' bedside. Target heart rate of >85% of the age-predicted heart rate was achieved in 96% of patients, and the mean rate-pressure product was 22,644 +/- 4,520 beats/min/mm Hg. The mean duration of the bedside pacing stress echocardiography test including technical preparations and image interpreta tion was 41 +/- 7 minutes. Pacing stress echocardiography and myocardial pe rfusion stress scintigraphy correlated well for identification or exclusion of inducible myocardial ischemia in 63 of 70 patients (90%) (kappa 0.81, p <0.001). The extent of inducible myocardial ischemia by vascular territori es correlated with myocardial perfusion stress scintigraphy in 52 of 70 pat ients (74%) (kappa 0.6, p <0.001). We conclude that bedside pacing stress e chocardiography is feasible and safe, and highly correlates with myocardial perfusion stress scintigraphy for identifying inducible myocardial ischemi a in patients with new onset of chest pain or unstable angina. (C) 2000 by Excerpta Medica, Inc.