Diagnosis of coronary artery disease in patients with permanent cardiac pacemaker by dobutamine stress echocardiography or exercise thallium-201 myocardial tomography
S. Ciaroni et al., Diagnosis of coronary artery disease in patients with permanent cardiac pacemaker by dobutamine stress echocardiography or exercise thallium-201 myocardial tomography, ECHOCARDIOG, 17(7), 2000, pp. 675-679
Citations number
19
Categorie Soggetti
Cardiovascular & Respiratory Systems
Journal title
ECHOCARDIOGRAPHY-A JOURNAL OF CARDIOVASCULAR ULTRASOUND AND ALLIED TECHNIQUES
This study evaluated the use of dobutamine stress echocardiography and exer
cise thallium-201 myocardial computed tomography (CT) in the diagnosis of c
oronary artery disease (CAD) in patients with permanent transvenous pacemak
er with the electrode implanted in the right ventricle (RV). Twenty-nine co
nsecutive patients with pacemaker underwent dobutamine stress echocardiogra
phy, exercise thallium-201 myocardial CT, and coronary arteriography over a
period of 8 +/- 1 days. None of these patients had suffered a myocardial i
nfarction (MI). The cardiac rhythm of every patient was electrically paced
during echocardiography and tomography. Sixteen. (55%) patients showed CAD
on angiography (stenosis greater than or equal to 50% of the luminal diamet
er of a major epicardial vessel). The detection sensitivity for CAD was 94%
for the tomography and 88% for the echocardiography (P = NS). The differen
ce between the sensitivities of the true techniques in detecting CAD based
on the affected coronary artery was not statistically significant. Of the 1
3 patients without CAD, tomography showed a positive result in nine cases,
i.e., a specificity of 31%, whereas echocardiography showed a positive resu
lt in only one case, i.e., a specificity of 92% (P < 0.01). Exercise thalli
um-201 myocardial computed tomography produces an increased rate of false-p
ositive results in patients with permanent transvenous cardiac pacemaker (P
CP) implanted in the right ventricle (RV). Dobutamine stress echocardiograp
hy can. thus be used to reduce considerably the level of false-positive res
ults in these patients and still retain, a detection sensitivity for CAD eq
ual to that of myocardial tomography.