宝田 明¹, 嶋谷 祐二¹, 佐々木 正太¹, 銕 寛之¹, 林 孝俊¹, 森田 哲夫², 都留 正人², 中島 義明², 吉田 浩¹

Akira TAKARADA¹, Yuhji SHIMATANI¹, Shouta SASAKI¹, Hiroyuki KUROGANE¹, Takatoshi HAYASHI¹, Tetsuo MORITA², Masato TSURU², Yoshiaki NAKAJIMA², Yutaka YOSHIDA¹

¹兵庫県立姫路循環器病センター循環器科, ²兵庫県立姫路循環器病センター放射線科

¹Department of Cardiology, Himeji Cardiovascular Center, ²Department of Radiology, Himeji Cardiovascular Center

キーワード : Stress echocardiography, Transesophageal atrial pacing, Coronary artery disease

A two-dimensional echocardiography was performed at rest and during rapid transesophageal atrial pacing in 36 patients undergoing coronary arteriography to evaluate chest pain (chest pain syndrome: 6 cases; vasospastic angina: 6 cases; effort angina: 24 cases). Transesophageal atrial pacing was performed with 30 to 50msec pulses of 6 to 16 V and 10 to 15 mA intensity; heart rate was progressively increased up to 150 beats/min. Transesophageal atrial pacing was performed successfully in 32 of 36 patients (89%). The sensitivity and specificity of the technique for detecting coronary artery disease (defined as a luminal diameter narrowing of at least 75% in one or more major vessels) were 88% and 88%, compared with 92% and 75% for thallium 201 myocardial scintigraphy with bicycle exercise. The sensitivity of transesophageal atrial pacing echocardiography for one, two or three vessel disease was 94%, 80%, and 100%, respectively. Ischemia-induced wall motion abnormalities were detected earlier than observed electrocardiographic changes and symptoms. Thus, two-dimensional echocardiography during transesophageal atrial pacing is a highly specific and sensitive technique for the detection of coronary artery disease.