After a positive stress echocardiography (stress echo), a coronary angiography is usually performed. When no significant lesion is found, the result is considered as a “false positive” test. Nevertheless, in some cases, new wall motion abnormality (WMA) during stress echo is large and clearly present for different observers. The aim of the present study was to evaluate the occurrence of large WMA during stress echo with normal coronary angiography in routine clinical practice.

Methods .– All patients referred for coronary angiography after a positive stress echo in our centre between April 2008 and October 2009 have been selected for the study. Stress echo were blindly analysed by two observers in order to specify the number of ischemic segments (new or worsening WMA).

Results .– Three hundred and seventy-nine patients (75% men, mean age 66 ± 10 years) have been included in the study. Mean number of ischemic segments at peak stress echo was 4 ± 1.5. Coronary artery stenosis > 50% (visual analysis) was present in 322 patients (85%). In 178 patients, stress echo was positive in a large area (≥ 4 segments). Among these patients, 19 (10.7%), had no significant coronary artery stenosis. This group included eight men (42%). Stress echo was performed during exercise in 17 patients and using dobutamine in 2. Peak systolic blood pressure was 193 ± 31 mmHg in these patients vs 193 ± 34 mmHg in patients with a large ischemic area (≥ 4 segments) but with significant coronary artery stenosis on angiography (ns).

Conclusion .– The item “false positive” stress echo must be discussed since nearly 10% of patients with a large ischemic area during the test have non significant coronary artery lesion. In our study, these patients were more often women evaluated during exercise. Systolic blood pressure level does not explain the WMA observed during the test.