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Prognostic relevance of a false-positive stress echocardiography response: a systematic review and meta-analysis
Sadie Bennett1,2, Prenali Dwisthi Sattwika3, Jacopo Tafuro1
1Heart & Lung Clinic, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK.
Insights
False-positive stress echocardiograms are common in patients with suspected ischemic heart disease. These results do not increase major adverse cardiovascular events compared to true positives, but more research is needed for comparison with true negatives.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Clinical Research
Background:
- Stress echocardiography is a key tool for assessing ischemic heart disease (IHD) and surgical risk.
- The prognostic significance of false-positive (FP) stress echocardiograms remains unclear despite higher major adverse cardiovascular event (MACE) rates in positive tests.
Purpose of the Study:
- To evaluate the prognostic relevance of false-positive (FP) stress echocardiogram results in patients with suspected or known ischemic heart disease (IHD).
Main Methods:
- A systematic literature search was conducted across major databases (Medline, Embase, etc.) up to April 2024.
- Included studies evaluated prognostic relevance of FP stress echocardiograms in IHD patients.
- Random effects meta-analysis compared MACE rates between FP, true-positive, and true-negative results.
Main Results:
- Five studies with 2426 patients were analyzed; 30.3% had FP results.
- MACE occurred in 28.8% of the FP group.
- Meta-analysis showed fewer MACE in FP compared to true-positive results (RR 1.64), but insufficient evidence for comparison with true negatives.
Conclusions:
- False-positive stress echocardiograms are frequent, particularly in patients with low pre-test IHD probability.
- FP results are not linked to increased MACE compared to true positives.
- More evidence is needed to determine if FP results identify high-risk patients versus true negatives.
Background:
Stress echocardiography is a widely available and used imaging modality in the assessment of ischaemic heart disease (IHD) and preoperative risk stratification. Despite the higher rate of major adverse cardiovascular events (MACE) observed in positive stress echocardiography results, the prognostic relevance of a false-positive (FP) stress echocardiogram is unclear.
Methods:
The authors searched Medline, Embase, CINAHL, Web of Science, The Cochrane Central Register of Controlled Trials, EBSCO Open Dissertation and Clinicaltrials.gov from inception to 15 April 2024, for studies evaluating the prognostic relevance of a FP stress echocardiogram response in patients with suspected or known IHD. Primary outcomes included the occurrence of MACE within the studied follow-up duration. Random effects meta-analysis was performed to evaluate the direction of effect and allow comparisons between FP, true-positive and true-negative stress echocardiography results.
Results:
A total of five studies were included with 2426 patients (mean age 56-66 years, 60.2% males). In total, there were 737 (30.3%) FP stress echocardiogram results. MACE occurred in 274 participants, of which 79 (28.8%) occurred within the FP stress echocardiography group. Meta-analysis from three studies demonstrated more MACE outcomes in patients with a true positive in comparison to a FP stress echocardiography result (RR 1.64, 95% CI: 1.22 to 2.20). Two studies reported increased MACE outcomes in patients with a FP result when compared with a true negative result.
Conclusions:
An FP stress echocardiogram result is common and frequently associated with patients who have a low pre-test probability for IHD. FP results are not associated with increased incidence of MACE when compared with true positive results; however, there is insufficient evidence to establish whether FP results in dobutamine stress echocardiography identify a cohort of high-risk patients in comparison to true negative results.
Prospero Registration Number:
CRD 42024526741.
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