Don Michael TA, Antonescu A, Bhambi B, Balasingam S Central Cardiology Medical Clinic, Los Angeles. Am J Cardiol 1996 Jan 15;77(2):187-90. Transthoracic echocardiography combined with transesophageal atrial pacing was performed in a community outpatient setting and compared with single-photon emission computed tomography (SPECT) and with coronary arteriography to determine the accuracy and usefulness of the technique. Two groups were defined: group A consisted of 65 of 189 patients who underwent all 3 procedures within a 90-day period; group B consisted of 53 patients who had atrial pacing with transthoracic echocardiography. Seventy-one patients had previously undergone atrial pacing with simultaneous transesophageal echocardiography. Atrial pacing to induce abnormal wall motion as an indicator of ischemia was performed by increasing the double product to > 20,000. We obtained a sensitivity and specificity of 87% and 88% for group A and 72% and 80% for group B, respectively. We believe that transthoracic echocardiography with atrial pacing is indicated as a means of stress echocardiography in its own right, especially in nonambulatory and chronotropically incompetent patients, as well as in the presence of an ambiguous result on SPECT testing. It is highly accurate compared with our previous study with atrial pacing and simultaneous transesophageal echocardiography, better tolerated, more easily accepted, less invasive, and less costly. Thus, it is a useful stress modality in the detection of myocardial ischemia.