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Detection of coronary stenoses by stress echocardiography using a previously implanted pacemaker for ventricular
D Benchimol1, M Mazanof, B Dubroca
1Service de Cardiologie et Maladies Vasculaires, Hôpital Cardiologique, Pessac, France.
Insights
A new stress echocardiography method using pacemaker pacing effectively detects coronary artery disease in pacemaker patients. This safe and feasible approach aids in diagnosing myocardial ischemia when standard ECG is difficult to interpret.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Medical Device Technology
Background:
- Increasing pacemaker use presents challenges in diagnosing coronary artery disease (CAD) and myocardial ischemia.
- Standard electrocardiogram (ECG) interpretation for ischemia is difficult in pacemaker patients.
- Noninvasive methods for assessing CAD in this population are limited.
Purpose of the Study:
- To evaluate a novel stress echocardiography technique for detecting significant coronary stenosis.
- To assess the feasibility and safety of using incremental ventricular pacing via implanted pacemakers for stress testing.
Main Methods:
- Prospective study of 25 patients with pacemakers undergoing stress echocardiography with incremental ventricular pacing.
- Pacing continued until 85% of age-predicted maximal heart rate or chest pain.
- Coronary angiography was performed to confirm stenosis presence and severity.
Main Results:
- The method was feasible and safe, with no complications reported.
- Stress echocardiography demonstrated a sensitivity of 77% and specificity of 90% for detecting significant coronary stenosis.
- Accuracy was 84%, with a positive predictive value of 91% and negative predictive value of 79%.
Conclusions:
- Incremental ventricular pacing stress echocardiography is a feasible, easy, and safe method.
- This technique is effective for detecting significant coronary stenoses in patients with pacemakers.
- It offers a valuable diagnostic tool for patients with pacemakers experiencing chest pain.
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.