Echocardiography and TRAS after myocardial infarction - transesophageal atrial stimulation - include

Author: Richard Sadovsky
Date: April, 1996

Studies show a strong relationship between prognosis following acute myocardial infarction and severity of left ventricular dysfunction, extent of coronary artery disease and presence of inducible ischemia. Early identification of inducible ischemia may result in more appropriate treatment. Res and associates evaluated the ability of combined transesophageal atrial stimulation (TRAS) and two-dimensional echocardiography performed soon after acute myocardial infarction to predict the probability of new ischemic events.

A total of 59 patients were successfully studied on days 3 to 5 after acute uncomplicated myocardial infarction. Selective coronary angiography was performed in all patients within two to three weeks after the acute phase. All of the patients were clinically-followed for at least one year.

All of the 59 patients studied had infarctrelated regional asynergy at rest. Asynergy was seen outside of the echocardiographic infarct zone in seven patients. These patients also had multivessel coronary disease. During TRAS, 26 patients had remote asynergy, including the seven with remote asynergy at rest. Multivessel disease was present (true positive) in 23 of these 26 patients and absent (false positive) in three. Of the 33 patients without remote asynergy during TRAS, 28 had one-vessel disease (true negative) and the remaining five had two-vessel disease. The sensitivity of remote asynergy (either at rest or induced by TRAS) in detecting multivessel coronary disease was 82 percent, the specificity was 90 percent, and the predictive accuracy was 86 percent.

The authors conclude that TRAS stress testing is safe soon after myocardial infarction and that asynergy was highly correlated with multivessel disease. Previous studies have demonstrated that stressinduced remote asynergy after myocardial infarction is highly linked to recurrent ischemic events. (Res JC, et al. Usefulness of combined two-dimensional echocardiography and transesophageal atrial stimulation early after acute myocardial infarction. Am J Cardiol 1995;76:1112-4.)

EDITOR'S NOTE: A limited exercise echocardiogram performed shortly after myocardial infarction is becoming more widely accepted as a predictor of future ischemic events than simple stress testing. The use of TRAS described by the authors allows measured stress without increased physical activity. The presence of predictors of future ischemic events indicates the need to consider early coronary angiography to study the possibility of revascularization.

COPYRIGHT 1996 American Academy of Family PhysiciansCOPYRIGHT 2004 Gale Group

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