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[Diagnosis of coronary disease using multiplane transesophageal echocardiography and atrial pacing]
C D Memmola1, V F Napoli, S Oliva
1Istituto di Cardiologia, Università degli Studi, Bari.
Insights
Transesophageal echocardiography with atrial pacing (TEE-TAP) accurately diagnoses coronary artery disease (CAD) by assessing left ventricular wall motion. This novel stress procedure offers high sensitivity and specificity for detecting CAD.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Medical Technology
Background:
- The diagnostic value of echo-pacing for coronary artery disease (CAD) has been established.
- Monoplanar transesophageal echocardiography (TEE) has been recently employed to enhance the reliability of stress procedures.
- Coronary angiography is the standard for CAD diagnosis but is invasive.
Purpose of the Study:
- To evaluate the accuracy of transesophageal echocardiography with atrial pacing (TEE-TAP) as a stress procedure for diagnosing CAD.
- To compare the diagnostic performance of TEE-TAP with traditional 12-lead electrocardiogram during atrial pacing.
Main Methods:
- Forty patients with suspected CAD underwent transesophageal echocardiography with atrial pacing (TEE-TAP).
- Atrial pacing was achieved using an electrode on the TEE probe, positioned in the esophagus or stomach.
- Left ventricular wall motion was monitored using multiplane TEE views at baseline, peak pacing, and post-pacing.
Main Results:
- TEE-TAP was successfully performed in 34 out of 40 patients (85% feasibility).
- The sensitivity and specificity of TEE-TAP for detecting CAD were 83% and 80%, respectively.
- TEE-TAP demonstrated higher sensitivity (72% vs. 66%) and specificity (92% vs. 40%) for multivessel disease compared to ECG.
Conclusions:
- Transesophageal echocardiography with atrial pacing (TEE-TAP) is a feasible and accurate new method for evaluating CAD.
- TEE-TAP provides comprehensive imaging of left ventricular wall motion, improving diagnostic accuracy for coronary artery disease.
- This technique offers a valuable non-invasive alternative for CAD diagnosis.
Abstract:
The diagnostic value of echo-pacing has been previously report. Recently, monoplanar transesophageal echocardiography (TEE) has been used to improve the reliability of this stress procedure. Therefore, in 40 consecutive patients undergoing coronary angiography for suspected coronary artery disease (CAD) we tested the accuracy of atrial pacing (TAP) during multiplane TEE as a stress procedure. TAP was performed during TEE using a circular, adhesive electrode installed at the tip of the echoscope and connected to the pulse generator. In all patients TAP was firstly attempted by positioning the TEE probe in the esophagus and, if not successful, in the stomach. Left ventricular wall motion was monitored by means of 4, 2 chamber and long axis views from the esophagus and short axis scan from the stomach, in baseline conditions, at peak pacing and immediately after maximal heart rate. The test was considered positive if wall motion abnormalities developed during TAP. Stable capture of the atrium was obtained in 28 patients from the esophagus and in 6 patients from the stomach. Thus, TEE-TAP was performed in 34/40 patients (feasibility 85%). Wall motion abnormalities were detected during TAP in 20/24 with and in 2/10 patients without CAD. Thus, sensitivity and specificity of TEE-TAP were 83% and 80% respectively. The sensitivity of the test in single and multivessel disease resulted 72% and 92%. The 12 lead electrocardiogram during TAP showed a sensitivity of 66% and a specificity of 40% (p < 0.01 vs TEE-TAP). In conclusion, TEE-TAP is a new approach for CAD evaluation providing a complete and accurate imaging of left ventricular wall motion.