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

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.