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KMID : 1146220200280020123
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Journal of Cardiovascular Imaging
2020 Volume.28 No. 2 p.123 ~ p.133
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Clinical and Echocardiographic Characterization of False-Positive Results from Stress Echocardiography
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Guerreiro Rui Azevedo
Fazendas Paula
Pereira Ana Rita
Marques Ana
Pais Joao
Alegria Sofia
Congo Kisa Hyde
Gomes Ana Catarina
Carvalho Joao
Morgado Goncalo
Cruz Ines
Almeida Ana Rita
Joao Isabel
Pereira Helder
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Abstract
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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.
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KEYWORD
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Echocardiography, Echocardiography, stress, Diagnostic errors, False positive reactions, Predictive value of tests
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