TheUseOfSimultaneousTransesophageal TwoDimensional EchocardiographyAndAtrialPacing InDetectionAnd Evaluation OfCoronaryArteryDisease.
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This study aimed at assessing the value and limitation of simultaneous transesophgeal Two Dimensional Echocardiography andAtrial pacing ( T.E. E. and At. Pacing) in comparison with treadmill Exercise Electrocardiogram(EX. ECG) in detection and evaluation of coronary artery disease. The study included 41 patients (28 males and 13 females) who presented with chest pain and scheduled to have coronary angiography for suspected coronary artery disease. Their ages were 52.6 6.8 years. Patients were divided into two groups according to their coronary angiography, group (I) with normal coronaries (10 patients) and group (II) with diseased vessels (31 patients). Group (II) was subdivided into three groupsA,BandCaccording to the number oftheir diseased vessels, single, double, or triple respectively. Before coronary angiography, patients were subjected to EX.ECGand TEE andAT. Pacing. The atrial pacing lead was fixed anterior to the transesophageal transducer, 3-5 cm. fromthe tip.A conventional pacing device (Medtronic pacing devicemodel number 5375)was used for atrial stimulation with maximum output andmaximumsensitivity.No detected complications occurred during the procedure. There were marked differences between T.E.E. and At pacing, and Ex .ECG. in sensitivity (96%Vs 79 %) , specificity (100%Vs 78%) and positive predictive value (96%Vs 75 % ) , for detection of coronary artery disease . The sensitivity ofT.E.E. and at. Pacing for assessment of the severity ofthe diseasewas higher than EX.ECG(100 %, 88 %, and 100%V s 50 %, 88 %, and 92 % for groups A, B, and C, respectively). In conclusion, the use of T.E.E. andAt. Pacing in detection and evaluation of coronary artery disease is a feasible, safe, promising new echocardiographic technique and can be recommended for evaluation ofpatients with physical handicap, poor exercise tolerance or with inadequate transthoracic echocardiographic imaging.