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Detection of left ventricular ischemia during atrial pacing: simultaneous assessment by echocardiography and invasive
1Department of Clinical Physiology, Haukeland Hospital, University of Bergen, Norway.
Insights
Echocardiography effectively detects myocardial ischemia during atrial pacing by identifying left ventricular dysfunction. This imaging technique can reveal inadequate regional perfusion, even when invasive methods show no signs of ischemia.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Coronary arterial disease poses significant risks.
- Detecting myocardial ischemia is crucial for patient management.
Purpose of the Study:
- To evaluate cross-sectional echocardiography's ability to detect myocardial ischemia induced by atrial pacing.
- To assess echocardiography's utility in identifying left ventricular dysfunction during induced ischemia.
Main Methods:
- 11 patients with coronary arterial disease underwent cardiac catheterization with atrial pacing.
- Quantitative echocardiographic assessment of wall motion and ventricular dimensions was performed.
- Hemodynamic measurements, including left ventricular end-diastolic pressure, were recorded.
Main Results:
- Atrial pacing precipitated angina pectoris in all patients.
- A significant increase in left ventricular end-diastolic pressure was observed post-pacing (P < 0.01).
- Regional left ventricular dysfunction and reduced systolic area (P < 0.01) and ejection fraction (P < 0.01) were detected by echocardiography.
Conclusions:
- Echocardiography can reliably detect pacing-induced myocardial ischemia.
- The technique identifies both regional and global left ventricular dysfunction.
- Echocardiography may indicate inadequate regional perfusion even when hemodynamic measurements are inconclusive.
Abstract:
The ability of cross-sectional echocardiography to detect myocardial ischemia induced by atrial pacing was assessed during cardiac catheterization in 11 patients with coronary arterial disease. Angina pectoris was precipitated in all patients with increase in left ventricular end-diastolic pressure after pacing by 5 +/- 6 (mean +/- standard deviation) mm Hg (P less than 0.01). Regional left ventricular dysfunction occurred during pacing in all patients as determined by quantitative echocardiographic assessment of wall motion. Simultaneously, systolic reduction in parasternal short-axis area decreased (from 42 +/- 13 to 28 +/- 9%, P less than 0.01) with concomitant decrease in ejection fraction as determined in the apical four-chamber view (from 49 +/- 5 to 40 +/- 8%, P less than 0.01). In conclusion, echocardiography may detect pacing-induced myocardial ischemia through detection of regional and global left ventricular dysfunction. Inadequate regional perfusion may be indicated by echocardiography even in patients without apparent evidence of ischemia as determined by invasive hemodynamic measurements.