J Cardiovasc Imaging.  2020 Apr;28(2):123-133. 10.4250/jcvi.2019.0109.

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

• Guerreiro RA
• Fazendas P
• Pereira AR
• Marques A
• Pais J
• Alegria S
• Congo KH
• Gomes AC
• Carvalho J
• Morgado G
• Cruz I
• Almeida AR
• João I
• Pereira H

• KMID: 2509454
• DOI: http://doi.org/10.4250/jcvi.2019.0109

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 true- and 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.

Keyword

Echocardiography; Echocardiography; stress; Diagnostic errors; False positive reactions; Predictive value of tests

Figure

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  Figure 1 Study design.

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  Figure 2 Distribution of stressors.

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  Figure 3 False-positive stress echocardiogram results by stressor.

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