Atrial Pacing with Two-Dimensional Echocardiography for Evaluation of Chest Pain: Comparison with Thallium 201 Scintigraphy

Atrial pacing was performed with two-dimensional (2-D) echocardiography and thallium 201 scintigraphy in 40 men with stable chest pain. Coronary an giography showed significant (one or more lesions ≥ 50%) coronary artery dis ease (CAD) in 36 patients and no or insignificant CAD in 4. Two dimensional echocardiography showed a left ventricular wall motion abnormality (WMA) either at rest or with pacing in 28 (78%) patients with CAD, with 17 (47%) show ing a new or worsened WMA with pacing. A thallium scan showing abnormali ty (reversible or fixed perfusion defect) was seen in 26 (72%) patients with CAD; 18 (50%) had a reversible defect. In all, 34 of the 36 patients with CAD (94%) had a WMA, a perfusion defect, or both (specificity 50%). Occurrence of both a WMA and a perfusion defect in individual segments ranged from 10 of 25 pa tients with septal abnormalities to 0 of 12 with abnormalities of the lateral seg ment. Sensitivity of 2-D echocardiography for identifying CAD in specific vessels was 81% for the left anterior descending (LAD) artery, 30% for the right coro nary artery, and 20% for the circumflex artery (both p < .001 compared with the LAD artery). Corresponding sensitivities for thallium 201 imaging were 54% (p