False-positive Stress Echocardiography: Not as Simple as It Looks

摘要

Stress echocardiography is a test with high sensitivity and specificity for detecting significant coronary artery stenosis, with similar diagnostic and prognostic accuracy to radionuclide stress perfusion imaging. Its average sensitivity and specificity have been reported to be 88% and 83%, respectively. As there are no biohazards or environmental impacts, stress echocardiography is the preferred screening method for coronary ischemia in spite of its dependence on operator training and image quality. The three most common stressors used in stress echocardiography are exercise, dobutamine, and dipyridamole, which are equally potent stressors for induction of regional wall motion abnormalities in the presence of critical epicardial artery stenosis. The endpoint for detection of myocardial ischemia is stress-induced transient change in regional wall motion. Wall motion assessment in stress echocardiography is more specific than perfusion imaging for predicting significant coronary stenosis (> 50% diameter coronary artery stenosis on coronary angiography), even though false positives are a continuing challenge for stress echocardiography.