The importance of two-dimensional echocardiography in conjunction with trans-esophageal stimulation of the left atrium for the diagnosis of myocardial ischemia

In 27 patients with coronary heart disease (group 1) and in 15 persons of ontrol group (group 2) transoesophageal left atrial pacing was performed. 12-lead ECG and two-dimensional echocardiography were done before and on the peak of the pacing. Changes of ST-segment (ST) and R-wave amplitude of V5 in the ECG (RV5) were analyzed. Left ventricular wall motion in the 11 segments and left ventricular enddiastolic volume index (LVEDVI), left ventrivular endsystolic volume index (LVESVI), stroke volume index (SVI), cardiac index (CI) and ejection fraction were studied by echocardiography. Sensitivity, specifity and predictive value confirming and excluding of coronary heart disease of the analyzed parameters were determined. During the analysis of ST-segment these values were 0.81, 0.67, 0.81 and 0.67 respectively. Diagnostic values of the analysis of the left ventricular wall motion and the ejection fraction were not statistically different (p greater than 0.05) from the analysis of ST-segment. During the analysis of LVEDVI, LVESVI, CI sensitivity of the transoesophageal atrial pacing was decreased and specifity was increased (p less than 0.05). The greatest value in the diagnosis of myocardial ischaemia during the two-dimensional echocardiography combined with transoesophageal left atrial pacing has the finding of the segmental asynergy of systole, diminution of EF and augmentation of LVESVI.