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PROGNOSTIC VALUE OF PACEMAKER STRESS ECHOCARDIOGRAPHY
Author(s) -
Kudrle C.,
Ferrari G.,
Manuale O.,
Ludueña C.E.,
Figueroa G.,
Estepo J.,
Caceres M.C.,
Gonzalez C.,
Humphreys. J.D.
Publication year - 2004
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/j.0742-2822.2004.t01-15-20040211.x
Subject(s) - medicine , mace , cardiology , atrial fibrillation , coronary artery disease , myocardial infarction , ejection fraction , aspirin , stress echocardiography , conventional pci , population , unstable angina , revascularization , heart failure , environmental health
Background: Transesophageal atrial pacing echocardiography is an accurate test for detection of coronary artery disease (CAD). In the expanding population of patients with permanent pacemakers, a pacing stress test can be administered noninvasively by external programming of the pacemaker. Objective: To establish the prognostic value of pacemaker stress echocardiography (PSE) to predict major adverse coronary events (MACE) in patients with suspected or known CAD. [MACE =CAD death, nonfatal myocardial infarction (MI), unstable angina (UA), or need of a myocardial revascularization procedure (MRP)]. Methods: From July 2000 to January 2003, 35 patients with a mean age of 73.9 ± 7 years with known or suspected CAD were consecutively submitted for PSE. Mean follow‐up was 12.8 ± 8 months. 31 patients (88.6%) with permanent implanted pacemakers (23 patients in DDD mode and 7 patients in VVI mode) underwent PSE by external programming and 4 patients (11.4%) had transesophageal atrial pacing performed. A 4‐stage protocol was used (base, 85%, 100% of maximum expected heart rate, and recovery), each lasting 3 minutes. Current medication was not discontinued. Patient features: men 19 (54.3%), hypertension 20 (57.1%), hypercholesterolemia 15 (42.9%), smoking 11 (31,4%), diabetes 10 (26.6%), atrial fibrillation: 5 (14.3%), previous MI 7 (20%), previous CABG 3 (8.6%), previous PCI 3 (8.6%), normal LVEF 27 (77.1%). Medical treatment: beta‐blockers 14 (40%), Ca‐antagonists 10 (28.6%), nitrates 1 (2.9%), ACE‐I/ARBS 11 (31.4%), aspirin 18 (51.4%), diuretics 5 (14.3%). Results: Ischemic PSE: 12 p (34,3%); High‐risk 1 patients (2.9%), intermediate‐risk 5 patients (14.3%), low‐risk 6 patients (17.1%). MACE: PCI: 1 patients (2.9%), non fatal MI: 1 patients (2.9%); CAD death and UA: 0 patients (0%). The negative predictive value (PV) of a non‐ischemic PSE was 95% and the positive PV of an ischemic PSE was only 8.3%. TABLE
MACE:
MACE (+)
MACE (−)
PV Non‐ischemic
PSE(12p)
111 Neg.PV Ischemic 1 22 Pos.PV 95% PSE(23p) 8.3%Conclusion: In this small cohort of patients with suspected or known CAD, a nonischemic PSE has a high negative PV.