Simultaneous transesophageal two-dimensional echocardiography and atrial pacing for detecting coronary artery disease.

This study describes a new technique for assessing wall motion abnormalities, combining transesophageal echocardiography (TEE) and transesophageal atrial pacing in 71 patients. Stable capture was reached in 70 patients (99%). In 3 patients (4%) pacing was discontinued prematurely because of discomfort. TEE during pacing was performed in 52 patients with and in 18 patients without coronary artery disease (CAD). In 43 of 52 patients with CAD, regional wall motion abnormalities occurred (sensitivity 83%). No wall motion abnormalities occurred in 17 of 18 patients without CAD (specificity 94%, positive predictive value 98%). Wall motion abnormalities related to another vascular region were observed in 17 of 22 patients with previous myocardial infarction (sensitivity 77%, specificity 100%, positive predictive value 100%). Simultaneous 12-lead electrocardiography during atrial pacing was performed in 57 patients and yielded positive results in 21 of 40 patients with (sensitivity 52%) and in 3 of 17 patients without (specificity 82%, positive predictive value 88%) CAD. Exercise stress testing was performed in 66 patients. Twenty-four of 48 patients with CAD had a positive exercise electrocardiogram (sensitivity 50%); a false-positive exercise electrocardiogram was observed in 3 of 18 patients (specificity 83%, positive predictive value 89%). It is concluded that TEE during transesophageal atrial pacing is a feasible and promising alternative technique for the assessment of CAD, with a higher sensitivity than simultaneous 12-lead and exercise electrocardiography.