Korean Circ J.  2008 Mar;38(3):140-143. 10.4070/kcj.2008.38.3.140.

Noninvasive Pacemaker Stress Echocardiography as a Screening Test for Coronary Artery Disease in Patients With Atypical Angina and Permanent Pacemaker

• Yoon HJ
• Her SH
• Do KR
• Lee JM
• Jin SW
• Youn HJ
• Lee MY
• Seung KB
• Rho TH
• Kim JH

• KMID: 2225830
• DOI: http://doi.org/10.4070/kcj.2008.38.3.140

Abstract

BACKGROUND AND OBJECTIVES
Making the noninvasive diagnosis of coronary artery disease in patients with a permanent pacemaker is difficult because of the inability to interpret electrocardiograms and the low specificity of perfusion scintigraphy. We evaluated the diagnostic accuracy of noninvasive pacemaker stress echocardiography (PASE) as a screening test for coronary artery disease in patients with atypical angina and a permanent pacemaker.
SUBJECTS AND METHODS
This a prospective study, and transthoracic stress-pacing echocardiography was performed on 15 patients (9 men and 6 women; age, mean age: 71.1+/-11.0 years) with atypical angina and a permanent pacemaker. All the patients underwent noninvasive pacemaker-stress echocardiography by external programming (pacing the heart rate up to 150 beats per minute). Coronary angiography was performed on the 8 patients with positive PASE results. Significant coronary artery disease was defined as > or =70% stenosis in at least one major coronary artery.
RESULTS
The echocardiographic images were interpretable for all the patients. No significant side effects were observed. The left ventricular systolic function was preserved in all the patients (left ventricular ejection fraction; 63.5+/-8%). Only 5 (62.5%) of 8 patients showed significant coronary artery disease, as documented by coronary angiography.
CONCLUSION
Noninvasive PASE is a simple, rapid, safe and diagnostically efficient test for detecting coronary artery disease in patients with atypical angina and a permanent pacemaker. Larger studies are necessary to validate our findings.

Keyword

Stress echocardiography; Coronary stenosis; Cardiac pacemaker, Artificial

MeSH Terms

Constriction, Pathologic
Coronary Angiography
Coronary Artery Disease
Coronary Stenosis
Coronary Vessels
Echocardiography
Echocardiography, Stress
Electrocardiography
Heart Rate
Humans
Male
Mass Screening
Pacemaker, Artificial
Perfusion Imaging
Prospective Studies
Sensitivity and Specificity

Figure

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  Fig. 1 Pacemaker stress echocardiography. A: baseline echocardiography showed normal regional wall motion. B: pacemaker stress echocardiography showed no regional wall thickening in the basal posterior wall (arrow) on the PLX view and inferior wall (two headed arrow) on the 2 ch view at fixed pacing of 100 bpm compared with those at baseline. PLX: parasternal long-axis, PSX: parasternal short-axis, 4 ch: four-chamber view, 2 ch: two-chamber view.

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  Fig. 2 Coronary angiography showed a significant stenosis in the mid-portion of the right coronary artery.

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