A rapid stress-testing protocol for the detection of coronary artery disease: Comparison of two-stage transesophageal atrial pacing stress echocardiography with dobutamine stress echocardiography

Andrew J. Rainbird, Patricia A. Pellikka, Vicky L. Stussy, Douglas M. Mahoney, James B. Seward

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

OBJECTIVES: We compared a new two-stage transesophageal atrial pacing stress echocardiography (TAPSE) protocol with a standard dobutamine stress echocardiography (DSE) protocol. BACKGROUND: Transesophageal atrial pacing stress echocardiography has been proposed as an efficient alternative to DSE. METHODS: Two-stage TAPSE (85% and 100% of age-predicted maximum heart rate) and DSE (5 to 40 μg/kg/min at 3-min stages with or without atropine) were both performed, in random sequence, in each patient of a study group of 36 patients. Regional wall-motion analysis, patient acceptance (1 = low, 5 = high), hemodynamics and duration for performing and interpreting tests were compared. RESULTS: Transesophageal atrial pacing stress echocardiography was successful in 35 of the 36 patients (feasibility 97%). More TAPSE than DSE studies were called 'ischemic' (37% vs. 14%; p = 0.005). Peak heart rate was higher with TAPSE (144 ± 18 vs. 129 ± 15 beats/min, p = 0.0001). Peak cardiac index (4.6 ± 2.1 vs. 5.1 ± 1.9 liters/min/m2, p = 0.14), patient acceptance score (4.2 ± 0.7 vs. 3.8 ± 1.3, p = 0.17) and study duration (14.2 ± 9.3 vs. 13.3 ± 3.3 min, p = 0.59) were similar. Recovery time (7.1 ± 7.6 vs. 16.2 ± 15.9 min, p = 0.0003) and interpretation time (9.1 ± 2.8 vs. 13.5 ± 4.4 min, p = 0.0001) were shorter for TAPSE than for DSE. CONCLUSIONS: Two-stage TAPSE permits rapid evaluation of cardiac patients. Peak cardiac index and patient acceptance scores were similar for TAPSE and DSE. Ischemia was detected more often with TAPSE; this result was attributed to the higher peak heart rate obtained with this protocol. (C) 2000 by the American College of Cardiology.

Original languageEnglish (US)
Pages (from-to)1659-1663
Number of pages5
JournalJournal of the American College of Cardiology
Volume36
Issue number5
DOIs
StatePublished - Nov 1 2000

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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