Clin. Cardiol. 23, 842–848 (2000)
Daniel Benchimol, M.D.,* Marc Mazanof, M.D.,* Bénédicte Dubroca, B.A.,† Hélène Benchimol, M.D.,* Virginie Bernard, M.D.,* Thierry Couffinhal, M.D., Ph.D.,* Jean François Dartigues, M.D., Ph.D.,† Raymond Roudaut, M.D.,* Xavier Pillois, Ph.D.,‡ Jacques Bonnet, M.D.*†
*Service de Cardiologie et Maladies Vasculaires, Hôpital Cardiologique, Pessac; Laboratoire de Biostatistiques et d'Epidémiologie, Université Victor Segalen Bordeaux 2, INSERM Unité 330, Bordeaux; ‡INSERM IFR no4, Pessac, France
Background: The number of patients with pacemakers has been increasing and a large number of them will present with chest pain or symptoms suggesting angina pectoris. Myocardial ischemia and presence of coronary artery disease are difficult to detect and assess by noninvasive methods in patients with a pacemaker; the electrocardiogram (ECG) at rest and during exercise is usually very difficult to analyze in terms of ischemia or even presence of an acute myocardial infarction.
Hypothesis: To detect significant coronary stenosis in patients with previously implanted pacemakers, we tested a new stress echocardiography method using incremental ventricular pacing by already implanted pacemakers.
Methods: We studied prospectively 25 consecutive patients who underwent stress echocardiography with increasing ventricular pacing up to either 85% of the age-predicted maximal heart rate or chest pain. Positive tests were defined by new hypokinesia or worsening of a preexisting alteration in wall motion in at least two adjacent territories. All patients underwent coronary angiograms to define the presence and severity of coronary stenoses.
Results: Among the 25 tests, 11 (44%) were stopped for chest pain, 1 (4%) for moderate discomfort, 1 (4%) for a drop in blood pressure, and the target pacing rate was achieved in the tests of the remaining 12 patients (48%). There were no complications. Thirteen patients had significant stenoses. In 10 cases, stress echocardiography was a true positive test with respect to coronary angiography. There were 11 true negative, 1 false positive, and 3 false negative tests. The sensitivity was 77%, specificity was 90%, the positive predictive value was 91%, and the negative predictive value 79%. The accuracy was 84%.
Conclusions: This new stress echocardiography method appears feasible, easy, safe, and effective for detection of significant coronary stenoses in patients with pacemakers.
Key words: stress echocardiography, pacemaker, ventricular pacing, coronary artery disease
Address for reprints:
Jacques Bonnet, M.D.
INSERM IFR no 4
Avenue du Haut-Lévêque
33600 Pessac, France
Received: July 29, 1999
Accepted with revision: January 26, 2000