Copyright © 1994 by the European Society of Cardiology.
© 1994 The European Society of Cardiology
Transoesophageal pacing echocardiography for detection of restenosis after percutaneous transluminal coronary angioplasty
Medical Clinic I, Klinikum RWTH Aachen Germany
*Department of Nuclear Medicine, Klinikum RWTH Aachen Germany
Received 22 July 1993; revised 24 January 1994; .
Correspondence: Rainer Hoffmann, MD, Medical Clinic I, Klinikum RWTH Aachen, Pauwelsstraße 30, D-52057 Aachen, Germany.
Abstract
Non-invasive documentation of restenosis after successful percutaneous transluminal coronary angioplasty (PTCA) remains a problem. Thus, transoesophageal pacing echocardiography (TPE) with simultaneous rapid atrial pacing via the same probe, a recently validated method for detection of coronary artery disease, was used in 60 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. Disease progression in previously normal vessels was noted in three additional patients. Results for detection of restenosis and disease progression were compared to exercise ECG and in 40 patients to Tc-99m methoxy-isobutyl-isonitrile (MIBI)-radionuclide perfusion imaging. Diagnostic standard exercise ECG could be performed 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 pacing or patient discomfort. Sensitivity of TPE for detection of restenosis and disease progression after PTCA was 84% compared with 50% and 86% for exercise ECG and Tc-99m MIBI-SPECT (P<0.03 and ns), respectively. Specificity of TPE (85%) was also higher than that of exercise ECG (59%, P<0.03) and comparable to the specificity of MIBI-SPECT (84%). Overall accuracy of TPE was 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-up after PTCA and is especially valuable in patients unable to perform a conventional exercise test.
Key Words: Coronary angioplasty • restenosis • transoesophageal pacing echocardiography • MIBI-SPECT
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