Accuracy and long-term prognostic value of pacing stress echocardiography compared with dipyridamole Tl emission computed tomography in patients with a permanent pacemaker and known or suspected coronary artery disease

Sara Shimoni, Sorel Goland, Shay Livshitz, Alexander Arditi, Oded Ayzenber, Fabio Kusniec, Gera Gendelman, Orly Edri, Gabi Lutati, Rosa Levi, Avraham Caspi, Menashe Epstein

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Objectives: Myocardial ischemia is difficult to assess by noninvasive methods in patients with a permanent pacemaker. Pacing stress echocardiography (PASE) has been used successfully in the detection of coronary artery disease (CAD). However, there are no data comparing PASE and other methods. Methods: We compared agreement and accuracy of PASE and radionuclide tomography (SPECT) in detecting CAD in 58 patients, mean age 75 ± 7 years, with a permanent pacemaker and known or suspected CAD. Thirty-nine patients underwent coronary angiography. The prognostic value of these tests was determined by prediction of cardiac events and cardiac death. Results: PASE and SPECT were positive in 39 and 43 patients, respectively. The agreement between the tests was 75%; kappa value 0.64. The sensitivity was 87 and 96% and the specificity 78 and 57%, respectively. With median follow-up of 51 months, there were 24 cardiac events and 8 cardiac deaths. Multivariable analysis determined that positive PASE was the only independent predictive factor associated with cardiac events and cardiac death. Conclusions: PASE is a feasible and effective method for detection of significant CAD in patients with permanent-pacemaker and allows effective risk stratification. PASE merits further study in larger prospective comparative studies.

Original languageEnglish
Pages (from-to)229-236
Number of pages8
JournalCardiology
Volume116
Issue number3
DOIs
StatePublished - Aug 2010
Externally publishedYes

Keywords

  • Coronary artery disease
  • Permanent pacemaker
  • Stress echocardiography

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