Key result
Pacing stress echocardiography (PASE) had 87% sensitivity and 78% specificity for detecting CAD, and a positive PASE independently predicted cardiac events and death over a median 51 months.
Why the study?
Does pacing stress echocardiography (PASE) improve diagnostic accuracy and prognostic prediction compared to SPECT in patients with a permanent pacemaker and known or suspected CAD?
Observational (n=58)
Does pacing stress echocardiography (PASE) improve diagnostic accuracy and prognostic prediction compared to SPECT in patients with a permanent pacemaker and known or suspected CAD?
Effect estimate: Agreement 75%, kappa 0.64
Absolute Event Rate: 87% vs 96%
Pacing stress echocardiography is a feasible and accurate method for detecting CAD that provides independent prognostic value for long-term cardiac events in patients with permanent pacemakers.
May support PASE for CAD evaluation in paced patients; leaves open its role versus SPECT pending prospective validation.
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.
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Shimoni et al. (2010) conducted an observational in Known or suspected coronary artery disease with a permanent pacemaker (n=58). Pacing stress echocardiography (PASE) vs. Radionuclide tomography (SPECT) was evaluated on Sensitivity for detecting CAD (Agreement 75%, kappa 0.64). Pacing stress echocardiography (PASE) had 87% sensitivity and 78% specificity for detecting CAD, and a positive PASE independently predicted cardiac events and death over a median 51 months.
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