Key result
An abnormal transesophageal atrial pacing stress echocardiography (TAPSE) was associated with a higher rate of cardiac death compared to a normal test (8.9% vs 3.6%).
Why the study?
Does an abnormal transesophageal atrial pacing stress echocardiography predict cardiac death in patients with known or suspected coronary artery disease?
Cohort (n=857)
Does an abnormal transesophageal atrial pacing stress echocardiography predict cardiac death in patients with known or suspected coronary artery disease?
Absolute Event Rate: 8.9% vs 3.6%
Transesophageal atrial pacing stress echocardiography is a useful prognostic tool for predicting long-term cardiac mortality in patients with known or suspected coronary artery disease.
May refine CAD risk assessment; leaves open incremental value over standard testing.
OBJECTIVES: It was the aim of this study to investigate the long-term value of transesophageal atrial pacing in predicting death in patients with known or suspected coronary artery disease. BACKGROUND: Exercise, dobutamine and dipyridamole stress echocardiography are all effective in predicting cardiac death. Transesophageal atrial pacing stress echocardiography (TAPSE) is a safe alternative to pharmacologic tests, but no information is available on prognosis with TAPSE. METHODS: One thousand and ten TAPSE were performed in 975 consecutive patients. TAPSE was feasible in 970 tests (96%); after exclusion of the 35 patients with more than 1 TAPSE and those 42 lost at follow-up (mean 4.5 +/- 3.7 years, median 6 years), the final population consisted of 857 patients (675 males, 58 +/- 9 years old). The Cox model was used to analyze the association of clinical, resting and TAPSE variables with cardiac death. RESULTS: TAPSE was abnormal in 281 (32%) patients. There were 46 cardiac-related deaths (5%), 25 among the 281 patients with an abnormal test (8.9%) and 21 among the 576 patients with a normal test (3.6%). The predictors of cardiac death were age, previous revascularization, resting wall motion score index and its variation during TAPSE. Abnormal TAPSE significantly increases the value of models predicting cardiac death. Moreover, cardiac mortality increased progressively with the extent of the induced ischemia. CONCLUSIONS: TAPSE is a useful tool in predicting death in patients with known or suspected coronary artery disease and might be considered an alternative to pharmacologic stressors.
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Anselmi et al. (2008) conducted a cohort in known or suspected coronary artery disease (n=857). Abnormal transesophageal atrial pacing stress echocardiography (TAPSE) vs. Normal TAPSE was evaluated on cardiac death. An abnormal transesophageal atrial pacing stress echocardiography (TAPSE) was associated with a higher rate of cardiac death compared to a normal test (8.9% vs 3.6%).
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