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False positive dobutamine stress echocardiograms: characterization of clinical, echocardiographic and angiographic
D S Bach1, D W Muller, B J Gros
1Department of Internal Medicine, University of Michigan, Ann Arbor 48109-0119.
Insights
False positive dobutamine stress echocardiograms often show small abnormalities in the posterior circulation, particularly in women. Some cases may indicate true ischemia or result from imaging limitations.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Echocardiography
Background:
- Dobutamine stress echocardiography (DSE) has lower specificity than sensitivity for diagnosing coronary artery disease.
- Sources of false positive DSE findings remain undefined.
- Understanding these false positives is crucial for accurate diagnosis.
Purpose of the Study:
- To characterize clinical, echocardiographic, and angiographic findings in patients with DSE-detected wall motion abnormalities but no critical coronary stenoses.
- To identify predictors and sources of false positive DSE results.
- To refine diagnostic criteria for DSE.
Main Methods:
- Retrospective review of patients with DSE-indicative wall motion abnormalities and <50% coronary stenoses.
- Utilized a 16-segment model for wall motion scoring.
- Independent angiogram review with digital caliper quantification of stenosis severity.
Main Results:
- 11.4% of studies (39/342) were false positives, predominantly in women (72%).
- Posterior circulation abnormalities (62%) were common, often limited to basal segments.
- 28% of abnormalities were associated with intermediate coronary stenoses (40.3%-68.1%).
Conclusions:
- False positive DSEs often involve small, basal posterior wall motion abnormalities.
- Intermediate coronary stenoses in ~1/3 of false positives may represent true ischemia.
- Poor endocardial visualization and tethering are potential sources of false positives.
- Altered DSE criteria for basal posterior abnormalities may be warranted.
Objectives:
This study was designed to characterize the clinical, echocardiographic and angiographic findings in patients who have regional wall motion abnormalities predictive of coronary artery disease on dobutamine stress echocardiograms, although coronary angiography reveals no critical stenoses.
Background:
The specificity of dobutamine stress echocardiography has been reported to be lower than its sensitivity; the sources of false positive findings on dobutamine stress echocardiograms have not been previously defined.
Methods:
Clinical and echocardiographic characteristics were retrospectively reviewed for patients who had both a dobutamine stress echocardiogram indicative of coronary artery disease on the basis of wall motion abnormalities and < 50% stenoses reported on coronary angiography performed within 6 weeks of the echocardiogram. A 16-segment model was used to perform wall motion scoring. Angiograms were independently reviewed, and stenosis severity was quantified with the use of digital calipers.
Results:
Thirty-nine (11.4%) of 342 studies met criteria for false positive test results, which occurred predominantly in women (72%, p < 0.001). Regional wall motion abnormalities were evident more often in the posterior circulation (62%), and 65% of them were limited to the basal segments. Twelve (28%) of 43 wall motion abnormalities were associated with coronary stenoses of at least intermediate grade (lumen diameter 40.3% to 68.1%). Abnormalities confined to basal segments of the posterior circulation were unlikely to have associated coronary lesions (p = 0.03).
Conclusions:
False positive findings on dobutamine stress echocardiograms tend to involve small wall motion abnormalities that are frequently located in basal segments of the posterior myocardial circulation. Approximately one third of false positive results occurred in patients with intermediate-grade coronary stenoses, and these studies may reflect true inducible ischemia. Additional sources of false positive study results may include poor endocardial visualization and abnormal motion due to tethering to the fibrous skeleton of the heart. Altered echocardiographic diagnostic criteria may be appropriate for small wall motion abnormalities confined to basal segments of the posterior circulation.