title: False-Positive Stress Echocardiograms: A Continuing Challenge.
abstract: BACKGROUND
  Stress echocardiography is an integral test in the cardiac diagnostic laboratory and has high sensitivity and specificity. Despite the excellent specificity of stress echocardiography, we continue to see a subset of patients with false-positive tests (defined as <50% diameter stenosis on subsequent coronary angiography). These false-positive findings present a management challenge because it remains unclear if and how to treat these patients.
  
  
  METHODS
  This article reviews relevant clinical studies and their outcomes.
  
  
  RESULTS
  Studies suggest that a group of patients develops a hypertensive response to exercise and therefore may have false-positive stress echocardiography. Hence, superior blood pressure control prior to stress echocardiography may prevent some false-positive tests. In addition, a subset of patients has microvascular abnormalities, vasomotor changes, endothelial dysfunction, and/or small vessel coronary disease that can lead to false-positive stress echocardiography.
  
  
  CONCLUSIONS
  The evidence is insufficient to state that a false-positive stress echocardiography in the absence of obstructive coronary artery disease portends a poor outcome, but considerable evidence shows that some of these patients have microvascular abnormalities and endothelial dysfunction and consequently may benefit from aggressive medical management and further testing.
authors.affiliation: Department of Cardiology, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Salima
authors.initials: S
authors.lastname: Qamruddin
keywords: Coronary artery disease; coronary stenosis; echocardiography–stress; false-positive reactions