Transoesophageal pacing echocardiography for detection of restenosis after percutaneous transluminal coronary angioplasty

Non-invasive documentation of restenosis after successful percutaneoustransluminal coronary angioplasty (PTCA) remains a problem.Thus, transoesophageal pacing echocardiography (TPE) with simultaneousrapid atrial pacing via the same probe, a recently validatedmethod for detection of coronary artery disease, was used in60 patients for detection of restenosis after successful PTCA(54 patients with one and six patients with multivessel PTCA).The patients came for routine follow-up angiography 5.4 ±3.7 months after PTCA regardless of clinical status. Restenosis(diameter stenosis 50%) was demonstrated in 22 patients. Diseaseprogression in previously normal vessels was noted in threeadditional patients. Results for detection of restenosis anddisease progression were compared to exercise ECG and in 40patients to Tc-99m methoxy-isobutyl-isonitrile (MIBI)-radionuclideperfusion imaging. Diagnostic standard exercise ECG could beperformed in only 38 patients, due to peripheral vascular disease,joint disease or premature exhaustion in the rest of patients.TPE was non-diagnostic in two patients due to ineffective pacingor patient discomfort. Sensitivity of TPE for detection of restenosisand disease progression after PTCA was 84% compared with 50%and 86% for exercise ECG and Tc-99m MIBI-SPECT (P<0.03 andns), respectively. Specificity of TPE (85%) was also higherthan that of exercise ECG (59%, P<0.03) and comparable tothe specificity of MIBI-SPECT (84%). Overall accuracy of TPEwas far superior to exercise ECG and similar to MIBI-SPECT (84%)vs 54% and 85%) (P=0.0007 and ns, respectively). We conclude that TPE is useful and accurate for patient follow-upafter PTCA and is especially valuable in patients unable toperform a conventional exercise test.