Pacemaker stress echocardiography predicts cardiac events in patients with permanent pacemaker |
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Authors: | Biagini Elena Schinkel Arend F L Elhendy Abdou Bax Jeroen J Rizzello Vittoria van Domburg Ron T Krenning Boudewijn J Schouten Olaf Branzi Angelo Rocchi Guido Simoons Maarten L Poldermans Don |
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Affiliation: | a Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands b Department of Internal Medicine, Section of Cardiology, University of Nebraska Medical Center, Omaha, Neb c Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands d Institute of Cardiology, S. Orsola Hospital, Bologna, Italy |
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Abstract: | PurposeNoninvasive pacemaker stress echocardiography is a newly introduced method for the diagnosis of coronary artery disease in patients with a permanent pacemaker. The prognostic value of pacemaker stress echocardiography has not been studied.Subjects and methodsWe studied 136 patients (mean age 64 ± 12 years) with a permanent pacemaker who underwent pacemaker stress echocardiography for evaluation of coronary artery disease. All patients underwent pacemaker stress echocardiography by external programming (pacing heart rate up to ischemia or target heart rate).ResultsThirty-one patients (23%) had normal study results. Ischemia was detected in 75 patients (55%). During a mean follow-up of 3.5 ± 2.4 years, 35 deaths (26%) (20 the result of cardiac causes) and 2 nonfatal myocardial infarctions (1%) occurred. The annual cardiac death rate was 1.3% in patients without ischemia and 4.6% in patients with ischemia (P = .01). The annual all-cause mortality rate was 3.1% in patients without ischemia and 7% in patients with ischemia (P = .004). The presence of ischemia during pacemaker stress echocardiography was the strongest independent predictor of cardiac death (hazard ratio 4.1, confidence interval 1.2-14.5) and all-cause mortality (hazard ratio 2.7, confidence interval 1.2-6.0) in a multivariable model.ConclusionMyocardial ischemia during pacemaker stress echocardiography is an independent predictor of cardiac death and all-cause mortality in patients with a permanent pacemaker. |
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Keywords: | Stress testing Echocardiography Pacemaker Prognosis |
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