Transesophageal atrial pacing stress echocardiography: difficulties in the performance and the interpretation of the test.

Introduction: Transesophageal atrial pacing stress echocardiography (TEAPSE) has been proposed as an alternative stress echo test in selected patients with known or suspected coronary artery disease. The purpose of this study was to determine: (1) whether TEAPSE could serve as a suitable provocative stress test in patients with stroke and (2) to investigate whether the pseudohypertrophy during TEAPSE that has been observed in experimental studies is also seen in the clinical setting.

Methods: TEAPSE at increasing heart rates was performed in 29 patients with stroke. The end-diastolic and end-systolic left ventricular (LV) wall/cavity circumferential area was traced and the ratio was calculated at each pacing stage, as well as the percent systolic thickening.

Results: A progressive increase in LV wall thickness was noted at high TEAPSE rates (from 1.31 +/- 0.21 mm at baseline to 1.47 +/- 0.27 mm at +50 beats/min of TEAPSE, p<0.05). The ratio wall/cavity area increased significantly at end diastole (from 1.65 +/- 0.36 at baseline to 2.12 +/- 0.49 at +50 beats/min, p<0.05). Percent systolic thickening was inversely correlated with the increase in wall thickness (r=-0.30, p<0.004) and the ratio wall/cavity area in diastole (r=-0.41, p<0.001). Feasibility of TEAPSE was 52% (15 of the 29 patients).

Conclusions: The occurrence of pseudohypertrophy during TEAPSE in conjunction with the low feasibility rate makes the performance and the interpretation of the test problematic. Therefore, other modalities of stress echocardiography should be considered for routine clinical use and TEAPSE could be applied in specific circumstances when other modalities are either contraindicated or unavailable.