False-Positive Stress Echocardiograms: A Continuing Challenge

• Published in: The Ochsner journal Vol. 16; no. 3; pp. 277 - 279
• Main Author: Qamruddin, Salima
• Format: Journal Article
• Language: English
• Published: United States Ochsner Clinic Foundation Academic Center - Publishing Services 01.01.2016; the Academic Division of Ochsner Clinic Foundation
• Subjects: Blood pressure; Cardiovascular disease; Coronary vessels; Electrocardiography; Fitness equipment; Hypertension; Ischemia; Laboratories; Medical imaging; Metabolism; Patients; Reviews and Contemporary Updates; Stents; Studies; Ultrasonic imaging; United States > US; coronary stenosis; false-positive reactions; Coronary artery disease; echocardiography–stress
• ISSN: 1524-5012

Stress echocardiography is an integral test in the cardiac diagnostic laboratory and has high sensitivity and specificity. Despite the excellent specificity of stress echocardiography, we continue to see a subset of patients with false-positive tests (defined as <50% diameter stenosis on subsequent coronary angiography). These false-positive findings present a management challenge because it remains unclear if and how to treat these patients. This article reviews relevant clinical studies and their outcomes. Studies suggest that a group of patients develops a hypertensive response to exercise and therefore may have false-positive stress echocardiography. Hence, superior blood pressure control prior to stress echocardiography may prevent some false-positive tests. In addition, a subset of patients has microvascular abnormalities, vasomotor changes, endothelial dysfunction, and/or small vessel coronary disease that can lead to false-positive stress echocardiography. The evidence is insufficient to state that a false-positive stress echocardiography in the absence of obstructive coronary artery disease portends a poor outcome, but considerable evidence shows that some of these patients have microvascular abnormalities and endothelial dysfunction and consequently may benefit from aggressive medical management and further testing.