Noninvasive pacemaker stress echocardiography as a screening test for coronary artery disease in patients with atypical angina and permanent pacemaker

Background and Objectives: Making the noninvasive diagnosis of coronary artery disease in patients with a permanent pacemaker is difficult because of the inability to interpret electrocardiograms and the low specificity of perfusion scintigraphy. We evaluated the diagnostic accuracy of noninvasive pacemaker stress echocardiography (PASE) as a screening test for coronary artery disease in patients with atypical angina and a permanent pacemaker. Subjects and Methods: This a prospective study, and transthoracic stress-pacing echocardiography was performed on 15 patients (9 men and 6 women; age, mean age: 71.1±11.0 years) with atypical angina and a permanent pacemaker. All the patients underwent noninvasive pacemaker-stress echocardiography by external programming (pacing the heart rate up to 150 beats per minute). Coronary angiography was performed on the 8 patients with positive PASE results. Significant coronary artery disease was defined as ≥70% stenosis in at least one major coronary artery. Results: The echocardiographic images were interpretable for all the patients. No significant side effects were observed. The left ventricular systolic function was preserved in all the patients (left ventricular ejection fraction; 63.5±8%). Only 5 (62.5%) of 8 patients showed significant coronary artery disease, as documented by coronary angiography. Conclusion: Noninvasive PASE is a simple, rapid, safe and diagnostically efficient test for detecting coronary artery disease in patients with atypical angina and a permanent pacemaker. Larger studies are necessary to validate our findings.