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Usefulness of Radionuclide Ventriculography During Transesophageal Atrial Pacing in the Diagnosis of Coronary Artery Disease

Department of Cardiology, Necker Hospital

Jean Louis Georges

Department of Cardiology, Necker Hospital

Jean Philippe Metzger

Department of Cardiology, Necker Hospital

Dominique Etienne

Department of Cardiology, Necker Hospital

Pierre Albarede

Department of Nuclear Medicine, Necker Hospital, Paris, France

Pierre de Vernejoul

Department of Nuclear Medicine, Necker Hospital, Paris, France

André Vacheron

Department of Cardiology, Necker Hospital

Radionuclide ventriculography before, during, and after atrial transesophageal pacing was carried out in 15 patients with suspected coronary artery disease (CAD) and without myocardial infarction. All patients underwent coronary angiography. Ten patients (group 1) had a coronary lesion > 50% on at least one of the main coronary arteries. Five patients (group 2) had normal coronary arteries. Radionuclide left ventricular ejection fraction (LVEF) before pacing was 56 ±3% in group 1 and 59 ±3% in group 2 (NS). Radionuclide ventriculography during pacing was 45 ±4% in group 1 (P < 0.0001 vs basal in group 1) and 45 ±6% in group 2 (P < 0.01 vs basal in group 2, NS vs group 1 during pacing). Immediate postpacing ejection fraction did not differ in the two groups and was identical to the prepacing value. A quantitative regional wall motion analysis was performed in 105 segments. Regional radionuclide ventriculography was calculated in each segment as follows: end-diastolic counts — end-systolic counts/end-diastolic counts. The relative decrease in regional LVEF during pacing was more important in the 39 segments related to a narrowed vessel than in the 66 segments related to normal coronary artery (32 ± 13% vs 13 ±10%, P < 0.0001). A more than 20% relative decrease in at least one segment during pacing occurred in 10 patients in group 1 (sensitivity 100%) and in 2 patients in group 2 (specificity 60%).

In conclusion, global radionuclide ventriculography during transesophageal atrial pacing decreases in patients with and without CAD. In contrast, regional wall motion abnormalities during pacing are more important in segments related to a narrowed coronary artery and can be proposed for patients unable to exercise as an alternative to pharmacologic stress test in the diagnosis of CAD.

Angiology, Vol. 45, No. 7, 621-628 (1994)
DOI: 10.1177/000331979404500705


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