الفهرس 
Material and methodsOnly 14 pages are availabe for public view
 |  | from | 207 |  |  |
| | | from | 207 | | |
Abstract
156
SUMMARY
This study included 41 patients who presented with chest pain and
scheduled to have cardiac catheterization and coronary angiography for
suspected coronary artery disease, their ages ranged between 38-68 years with an
average of 52.6 years. There were 23 males and 13 females.
24 patients were smoker, 27 patients were hypertensive, 15 patients were
diabetic, 25 patients had a history of high cholesterol level, and 17 patients had a
history of previous myocardial infarction.
17 patients had a pathological Q wave of the myocardial infarction in the
resting twelve lead electrocardiogram, and 14 patients had increased
cardiothoracic ratio by postero- anterior chest x-ray film.
26 patients had resting wall motion abnormalities by transthoracic
echocardiography, the mean resting wall motion score index was 1.26 and the
mean ejection fraction was 56.4%. 29 patients had left ventricular diastolic
dysfunction.
25 patients had a positive exercise ECG testing, 13 patients had a negative
test, and 3 patients had an inconclusive test.
30 patients had a positive stress transesophageal echocardiography and
11 patients had a negative test with a mean maximum of paced heart rate was
143.7 beats/minute. The mean resting wall motion score index was 1.36 and the
mean wall motion score index at the maximum paced heart rate was 1.57 with
significant difference (P value < 0.05).
157
10 patients (Group I) had a normal coronary angiography and 31 patients
(Group II) had diseased coronary arteries. 10 patients (Group A) had single
coronary artery disease, 9 patients (Group B) had double coronary artery
disease, and 12 patients (Group C) had triple coronary artery disease with the
mean ejection fraction was 53.4%.
There were significant differences between Grol(JlI and U in the following
Age, maximum achieved heart rate during exercise ECG testing,
maximum paced heart rate and chest pain during stress TEE. (P value <
0.05).
There were highly signifiCant differenceS between Grol(JlI and U in the following
dJlm;
Sex, smoking, history of high lipid level, history of previous myocardial
infarction, transthoracic echocardiographic ejection fraction, resting wall motion
score index, left ventricular diastolic dysfunction ,chest pain during exercise
ECG testing, resting transesophageal wall motion score index, stress
transesophageal wall motion score index and ejection fraction by cardiac
catheterization. (p value < 0.01 )
There were sjgnificant differenceS between group A. B. and C jn the
following data:
Transthoracic echocardiographic ejection fraction, resting wall motion
score index, maximum paced heart rate, resting transesophageal wall motion
score index, stress transesophageal wall motion score index and ejection fraction’
by cardiac catheterization. (P value < 0.05).
158
Exercise ECG testing had a 79 % sensitivity, 78 % specificity and 75 %
positive predictive value.
Stress transesophageal echocardiography had a 96% sensitivity, 100%
specificityand 96% positive predictive value.
There were significant differences between exercise ECG testing and stress
transesophageal echocardiography in sensitivity, specificity and predictive value
The sensitivity of exercise ECG testing for group A, Band C were
respectively 50%, 88% and 92%. and for stress transesophageal
echocardiography were respectively 100%, 88% and 100%.
In conclusion,the use of simultaneous transesophageal echocardiography
and transesophageal atrial pacing in detection and evaluation of coronary heart
disease is a feasible, safe, promising new echocardiographic stress technique and
can be recommended for evaluation of patients with physical handicap or
poor exercise tolerance with inadequate transthoracic echocardiographic
imaging .
- -----