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Noninvasive pacemaker stress echocardiography for diagnosis of coronary artery disease: a multicenter study
Eugenio Picano1, Annalisa Alaimo, Vlad Chubuchny
1Institute of Clinical Physiology, Pisa, Italy. picano@ifc.cnr.it
Insights
The noninvasive pacemaker stress echocardiography (PASE) test is a safe and accurate method for diagnosing coronary artery disease (CAD) in patients with permanent pacemakers. This pacing stress test offers high sensitivity and specificity, making it a valuable diagnostic tool.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Noninvasive Testing
Background:
- Transesophageal atrial pacing echocardiography is accurate for CAD detection but invasive.
- Permanent pacemaker (PM) patients offer an opportunity for noninvasive pacing stress tests via external PM programming.
Purpose of the Study:
- Evaluate the feasibility, safety, and diagnostic accuracy of noninvasive pacemaker stress echocardiography (PASE).
- Assess PASE as an alternative to exercise or pharmacologic stress testing for suspected or known coronary artery disease (CAD).
Main Methods:
- Prospective, multicenter study of 46 patients with permanent PMs and suspected/known CAD.
- Noninvasive PM-stress test with external programming; coronary angiography performed for all patients.
- Significant CAD defined as >/=50% diameter reduction in major epicardial coronary arteries.
Main Results:
- PASE was feasible and safe, with interpretable echocardiographic images in all patients.
- Sensitivity, specificity, and accuracy for significant CAD were 70%, 90%, and 78% respectively.
- Modified criteria (unchanged abnormal wall motion) improved sensitivity to 85%, specificity to 84%, and accuracy to 85%.
Conclusions:
- Noninvasive PASE is a simple, rapid, safe, and diagnostically efficient option for patients with permanent PMs and suspected or known CAD.
- PASE demonstrates high diagnostic performance, supporting its use as an alternative stress test.
Objective:
We evaluated the feasibility, safety, and diagnostic accuracy of noninvasive pacemaker stress echocardiography (PASE) test as a potential alternative to exercise or pharmacologic stress in patients with suspected or known coronary artery disease (CAD).
Background:
Transesophageal atrial pacing echocardiography is an accurate test for detection of CAD, but its practical impact has been blunted by semi-invasiveness. In the expanding population of patients with permanent pacemakers (PMs), a pacing stress test can be administered noninvasively by external programming of the PM.
Methods:
In a prospective, multicenter, international study design, transthoracic stress-pacing echocardiography was performed in 46 consecutive patients with a permanent PM (33 men, 13 women; age 66.6 +/- 11.1 years) with suspected or known CAD. All patients underwent noninvasive PM-stress test by external programming (10 beats/min increments up to ischemia or target heart rate). Coronary angiography was performed in all patients independently of test results. Significant CAD was defined as >/=50% visually assessed diameter reduction in at least one major epicardial coronary artery. All coronary angiograms were scored by Duke prognostic weight values.
Results:
Fifteen patients were stimulated in atrial, and the remaining 31 in ventricular mode during stress. No significant side effects were observed. Echocardiographic images were interpretable in all patients. The average duration of stress was 8.9 +/- 3.5 min. Significant CAD was found in 27 patients. Sensitivity of PASE for identifying patients with significant CAD was 70%, specificity was 90%, and accuracy was 78%. When any abnormal wall motion at rest that remained unchanged at peak stress was regarded as a positive result of PASE, then the sensitivity, specificity, and accuracy levels for identifying patients with significant CAD were 85%, 84%, and 85%, respectively. Four of the eight patients with a false negative did not reach the target heart rate. The Duke values had significant correlation with values of wall motion score index at peak stress (r = 0.67) and with peak heart rate (r = -0.3).
Conclusions:
Noninvasive PASE is a simple, rapid, safe, and diagnostically efficient option for patients with permanent PM and suspected or known CAD.