A rapid stress-testing protocol for the detection of coronary artery disease - Comparison of two-stage transesophageal atrial pacing stress echocardiography with dobutamine stress echocardiography

OBJECTIVES We compared a new two-stage transesophageal atrial pacing stress echocardiography (TAPSE) protocol with a standard dobutamine stress echoca rdiography (DSE) protocol. BACKGROUND Transesophageal atrial pacing stress echocardiography has been p roposed as an efficient alternative to DSE. METHODS Two-stage TAPSE (855 and 100% of age-predicted maximum heart rate) and DSE (5 to 40 mug/kg/min at 5-min stages with or without atropine) were both performed, in random sequence, in each patient of a study group of 36 patients. Regional wall-motion analysis, patient acceptance (1 = low, 5 = h igh), hemodynamics and duration for performing and interpreting rests were compared. RESULTS Transesophageal atrial pacing stress echocardiography was successfu l in 35 of the 36 patients (feasibility 97%). More TAPSE than DSE studies w ere called "ischemic" (37% vs. 14%; p = 0.005). Peak heart rate was higher With TAPSE (144 +/- 18 vs. 129 +/- 15 beats/min, p = 0.0001). Peak cardiac index (4.6 +/- 2.1 vs. 5.1 +/- 1.9 liters/min/m(2), p = 0.14), patient acce ptance score (4.2 +/- 0.7 vs. 3.8 +/- 1.3, p = 0.17) and study duration (14 .2 +/- 9.3 vs. 13.3 +/- 3.3 min, p = 0.59) were similar. Recovery time (7.1 +/- 7.6 vs. 16.2 +/- 15.9 min, p = 0.0003) and interpretation time (9.1 +/ - 2.8 vs. 13.5 +/- 4.4 min, p = 0.0001) were shorter for TAPSE than for DSE . CONCLUSIONS Two-stage TAPSE permits rapid evaluation of cardiac patients. P eak cardiac index and patient acceptance scores were similar for TAPSE and DSE. Ischemia was detected more often witll TAPSE; this result was attribut ed to the higher peak heart rate obtained with this protocol. (C) 2000 by t he American College of Cardiology.