Zabalgoitia M, Gandhi DK, Abi-Mansour P, Yarnold PR, Moushmoush B, Rosenblum J. University of Texas Health Science Center, San Antonio. Am Heart J 1991 Nov;122(5):1456-63 A new nonexercise test to detect significant coronary disease was prospectively evaluated in 36 patients with chest pain syndrome and normal left ventricular contractility. Transesophageal atrial pacing was used to provoke ischemia during monitoring of left ventricular contractility by transesophageal echocardiography. A 12-lead ECG was recorded. A TSE was abnormal if new segmental wall motion abnormalities developed. On the basis of the TSE results, patients were separated into normal (group 1, n = 16) and abnormal response (group 2, n = 20). Arteriography revealed significant disease in 21 patients, 19 from group 2 and two from group 1. Sensitivity and specificity of TSE were 90% and 93%, respectively, and those for pacing ECG were 43% and 100%, respectively. In addition, TSE accurately predicted the coronary artery perfusion bed involved. In 10 patients, Wenckebach AV block developed during pacing and resolved immediately by the administration of atropine sulfate. No serious complications were seen. Thus TSE is a highly sensitive and specific novel technique to detect significant coronary disease in patients with chest pain syndrome and normal resting left ventricular contractility.