Detection of coronary stenoses by stress echocardiography using a previously implanted pacemaker for ventricular pacing: Preliminary report of a new method
D. Benchimol et al., Detection of coronary stenoses by stress echocardiography using a previously implanted pacemaker for ventricular pacing: Preliminary report of a new method, CLIN CARD, 23(11), 2000, pp. 842-848
Background: The number of patients with pacemakers has been increasing; and
a large number of them will present with chest pain or symptoms suggesting
angina pectoris. Myocardial ischemia and presence of coronary artery disea
se are difficult to detect and assess by noninvasive methods in patients wi
th a pacemaker; the electrocardiogram (ECG) at rest and during exercise is
usually very difficult to analyze in terms of ischemia or even presence of
an acute myocardial infarction.
Hypothesis: To detect significant coronary stenosis in patients with previo
usly implanted pacemakers, we tested a new stress echocardiography method u
sing incremental ventricular pacing by already implanted pacemakers.
Methods: We studied prospectively 25 consecutive patients who underwent str
ess echocardiography with increasing ventricular pacing up to either 85% of
the age-predicted maximal heart rate or chest pain. Positive tests were de
fined by new hypokinesia or worsening of a preexisting alteration in wall m
otion in at least two adjacent territories. All patients underwent coronary
angiograms to define the presence and severity of coronary stenoses.
Results: Among the 25 tests, 11 (44%) were stopped for chest pain, 1 (4%) f
or moderate discomfort, 1 (4%) for a drop in blood pressure, and the target
pacing rate was achieved in the tests of the remaining 12 patients (48%).
There were no complications. Thirteen patients had significant stenoses. In
10 cases, stress echocardiography was a true positive test with respect to
coronary angiography. There were 11 true negative, 1 false positive, and 3
false negative tests. The sensitivity was 77%, specificity was 90%, the po
sitive predictive value was 91%, and the negative predictive value 79%. The
accuracy was 84%.
Conclusions: This new stress echocardiography method appears feasible, easy
, safe, and effective for detection of significant coronary stenoses in pat
ients with pacemakers.