False-Positive Stress Echocardiograms: A Continuing Challenge

Area of Science:

• Cardiology
• Diagnostic Imaging
• Clinical Medicine

Background:

• Stress echocardiography is a sensitive and specific cardiac diagnostic tool.
• A subset of patients exhibits false-positive stress echocardiography results, defined as less than 50% diameter stenosis on coronary angiography.
• These false-positive findings create management dilemmas due to uncertainty in treatment strategies.

Purpose of the Study:

• To review clinical studies and outcomes related to false-positive stress echocardiography.
• To identify potential causes and implications of false-positive stress echocardiography.
• To explore management strategies for patients with false-positive stress echocardiography in the absence of obstructive coronary artery disease.

Main Methods:

• Review of relevant clinical studies.
• Analysis of patient outcomes associated with stress echocardiography findings.
• Examination of physiological and pathological factors contributing to false-positive results.

Main Results:

• A hypertensive response to exercise is associated with false-positive stress echocardiography.
• Microvascular abnormalities, vasomotor changes, endothelial dysfunction, and small vessel coronary disease can lead to false-positive results.
• Improved blood pressure control before stress echocardiography may reduce false-positive rates.

Conclusions:

• Insufficient evidence exists to confirm poor outcomes for false-positive stress echocardiography without obstructive coronary artery disease.
• A significant portion of these patients demonstrate microvascular abnormalities and endothelial dysfunction.
• Aggressive medical management and further testing may be beneficial for patients with microvascular dysfunction and false-positive stress echocardiography.