Quantitative assessment of transient left ventricular asynergy in coronary artery disease

The purpose of this study was to determine the diagnostic value of quantitative two‐dimensional echocardiography during transesophageal atrial pacing in assessing the presence and severity of coronary artery disease. Apical four‐ and two‐chamber views were registered at rest and at different pacing rates. Computerized quantitative evaluation of left ventricle wall motion was performed. On the basis of left ventricle wall motion analysis data of 22 individuals with no coronary pathology, as assessed by angiography and with negative exercise ECG and transesophageal atrial pacing ECG test, nomograms for assessment of wall motion abnormalities and for calculation of asynergy area as a measure of wall motion abnormality extent were obtained. The method revealed new transient wall motion abnormalities during pacing or exacerbation of old ones present at rest in 83 of the 89 patients with angiographically proven coronary artery stenosis ⩾70% and in 3 of the 32 controls with no changes in their coronary angiograms. Thus, it showed high sensitivity (93%), specificity (91%), predictive value of positive result (96%), predictive value of negative result (83%), and efficiency of the test (93%). These values appeared to be higher than those calculated for transesophageal atrial pacing ECG, recorded simultaneously with echocardiographic images (81, 87, 95, 62, and 83%, respectively) and for exercise ECG test which was performed in 66 coronary patients and in 29 controls (68, 86, 92, 54, and 74%, respectively). The extent of pacing‐induced left ventricular regional wall motion abnormalities appeared to be directly correlated to the extent of coronary artery disease. Thus, transesophageal atrial pacing two‐dimensional echo stress testing seems to be a valuable method for the evaluation of coronary artery disease and for the assessment of its extent.