Usefulness of combined two-dimensional echocardiography and transesophageal atrial stimulation early after acute myocardial infarction

Transesophageal atrial stimulation (TRAS) was combined with 2-dimensional echocardiography in 69 consecutive patients on days 3 to 5 (mean 3.3) of their first, uncomplicated myocardial infarction, to determine if inducible remote asynergy (i.e., not directly adjacent to the infarcted area and supposedly related to another vascular territory) provides information regarding (1) extent of coronary artery disease, and (2) future ischemic events. Uncomplicated, adequate stress studies were performed in 59 of 69 patients (86%); all these patients had regional asynergy at rest. Remote asynergy at rest was present in 7 patients and during TRAS in 26 patients. Coronary angiography was performed within 2 to 3 weeks after the acute phase. Multivessel disease was present in 23 of these patients and absent in 3. Of the 33 patients without remote asynergy during TRAS, 5 had multivessel disease. Sensitivity of remote asynergy during TRAS for detecting multivessel CAD was 82%, specificity 90%, and predictive accuracy 86%. New ischemic events, defined as recurrent infarction, cardiac death, or revascularization within 12 to 18 months (mean 12.6) occurred in 24 patients (41%); remote asynergy during TRAS was present in 16 of these patients (67%). It is concluded that TRAS combined with 2-dimensional echocardiography can safely be performed in the early days of acute myocardial infarction; remote asynergy during TRAS reliably identifies patients with multivessel disease and future ischemic events.