Pacing stress echocardiography: An alternative to pharmacologic stress testing

OBJECTIVES We sought to evaluate the diagnostic accuracy and feasibility of bedside pacing stress echocardiography (PASE) as a potential substitute fo r pharmacologic stress echocardiography in patients admitted to the hospita l with new-onset chest pain or worsening angina pectoris. BACKGROUND Accurate and rapid noninvasive identification and evaluation of the extent of coronary artery disease (CAD) Is essential for optimal manage ment of these patients. METHODS Bedside transthoracic stress echocardiography was performed in 54 c onsecutive patients admitted to a community hospital with new-onset chest p ain, after acute myocardial infarction had been excluded. We used 10F trans esophageal pacing catheters and a rapid and modified pacing protocol. The P ASE results were validated in all patients by coronary angiography performe d within 24 h of the test. Significant CAD was defined as greater than or e qual to 75% stenosis in at least one major epicardial coronary artery. RESULTS The sensitivity of PASE for identifying patients with significant C AD was 95%, specificity was 87% and accuracy was 92%. The extent of signifi cant CAD (single- or multivessel disease) was highly concordant with corona ry angiography (kappa = 0.73, p < 0.001). Pacing stress echocardiography wa s well tolerated, and only 4% of the patients had minor adverse events. The mean rate-pressure product at peak pacing was 22,313 +/- 5,357 beats/min p er mm Hg, and heart rate >85% of the age-predicted target was achieved in 9 4% of patients. The average duration of the bedside PASE test, including im age interpretation, was 38 +/- 6 min. CONCLUSIONS Bedside PASE is rapid, tolerable and accurate for identificatio n of significant CAD in patients admitted to the hospital with new-onset ch est pain or worsening angina pectoris. (C) 2000 by the American College of Cardiology.