Open AccessDetection of coronary stenoses by stress echocardiography using a previously implanted pacemaker for ventricular pacing: Preliminary report of a new method
Author(s) -
Benchimol Daniel,
Mazanof Marc,
Benchimol HÉLÈNe,
Bernard Virginie,
Couffinhal Thierry,
Roudaut Raymond,
Dubroca BÉNÉDicte,
Dartigues Jean François,
Bonnet Jacques,
Pillois Xaver
Publication year - 2000
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.4960231111
Subject(s) - medicine , cardiology , chest pain , myocardial infarction , coronary artery disease , stress echocardiography , stress testing (software) , angina , electrocardiography , unstable angina , hypokinesia , stenosis , computer science , programming language
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 disease are difficult to detect and assess by noninvasive methods in patients with 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 previously implanted pacemakers, we tested a new stress echocardiography method using incremental ventricular pacing by already implanted pacemakers. Methods: We studied prospectively 25 consecutive patients who underwent stress echocardiography with increasing ventricular pacing up to either 85% of the age‐predicted maximal heart rate or chest pain. Positive tests were defined by new hypokinesia or worsening of a preexisting alteration in wall motion 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%) for 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 positive 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 patients with pacemakers.