Clinical and Echocardiographic Characterization of False-Positive Results from Stress Echocardiography

Abstract

BACKGROUND: Stress echocardiography has a 72%-85% sensitivity and an 80%-95% specificity. In this study, we characterized patients who received a false-positive stress echocardiogram result. METHODS: A total of 5,256 patients underwent a stress echocardiogram (induced by exercise, dobutamine, or dipyridamole) between 2009 to 2018, and 405 patients (7.7%) received a positive result. Among the positive patients, 300 underwent coronary angiography within 12 months, and these patients were included in this study (mean age = 64.9 ± 9.4 years, 230 men [76.7%]). Coronary artery disease was diagnosed by stenosis ≥50% in any epicardial coronary artery. Clinical and echocardiographic variables were compared between patients with trueand false-positive stress echocardiogram results. RESULTS: Seventy-two patients (24%) had a false-positive stress echocardiogram, with similar rates across stressor types (p = 0.574). Patients with false positives were less frequently men (63.9% vs. 80.7%, p = 0.003), had lower diabetes mellitus prevalence (15.3% vs. 45.6%, p = 0.001), were similar to true positive patients with regard to body-mass index, arterial hypertension prevalence, hyperlipidemia and smoking, and had lower pre-test probability of coronary artery disease (23% vs. 32%, p = 0.016). The wall motion score index (WMSI) was higher in the true-positive stress group, and wall motion abnormalities were more frequent in the apical segments (70.5% vs. 56.7%, p = 0.034). In a multivariable predictive model, men (odds ratio [OR] = 2.994), diabetes (OR = 5.440), and peak WMSI (OR = 10.690) were associated with a true-positive result. CONCLUSIONS: Twenty-four percent of our study population received a false-positive stress echocardiogram result, with similar rates across stressor types. Patients with true-positive stress echocardiogram results are more likely to be men, diabetic, and have a high peak WMSI.

Modified Haller index is inversely correlated with true positive exercise stress echocardiographic results

“…The prevalence of FP stress echocardiographic results detected in our cohort of patients (24.1%) was similar to that observed in our previous investigation (19.4%) 14 and to that detected by other authors 25 …”

“…A true positive stress echocardiographic result was defined as a positive ESE with obstructive CAD (≥70% stenosis) according to subsequent coronary angiography. An FP stress echocardiographic result was defined as a positive ESE with no evidence of obstructive CAD (<70% stenosis) according to subsequent coronary angiography 25 . Ischemic ECG changes during noninvasive testing, in the absence of both regional wall motion abnormalities and obstructive CAD by coronary angiography, were attributed to possible microvascular dysfunction 26 …”

The feasibility, reliability, and incremental value of two-dimensional speckle-tracking for the detection of significant coronary stenosis after treadmill stress echocardiography

“…However, substantial expertise and experience are required to achieve optimal diagnostic accuracy [ 2 ]. Furthermore, a significant proportion of false-positive ESEs may occur, resulting in unnecessary normal coronary angiograms [ 3 , 4 ]. The development of practical quantitative analysis techniques to increase the diagnostic yield of ESE has been a primary research focus [ 1 ].…”

Influence of Changes in Pretest-probability for Chronic Coronary Syndromes on Diagnostic Performance of Dobutamine Stress Echocardiography

“…Among these, dobutamine stress echocardiography (DSE), which detects myocardial ischemia through assessing wall motion abnormalities during pharmacologic stress, has considerable sensitivity and specificity, and is widely accessible with a comparable low cost. 8) 9) …”