Cardiomyopathy
Are Some False-Positive Stress Echocardiograms a Forme Fruste Variety of Apical Ballooning Syndrome?

https://doi.org/10.1016/j.amjcard.2009.01.352Get rights and content

The mechanisms for abnormal stress echocardiograms (SEs) in patients with normal coronary arteries have not been clearly elucidated. We hypothesized that in some patients, this phenomenon may represent a forme fruste of apical ballooning syndrome (ABS). The aim of the study was to evaluate the characteristics of patients with strongly false-positive SEs and determine whether there were similarities to ABS. Thirty-one patients from the Mayo Clinic stress echocardiography database who had normal function at rest, extensive regional wall motion abnormalities in association with an abnormal response of left ventricular end-systolic cavity size at peak stress, and angiographically normal coronary arteries were evaluated. Eighty-four percent were women with a mean age of 61 ± 12 years, 6% had a positive stress electrocardiogram, and only 26% had a hypertensive response to stress. In 81%, left ventricular ejection fraction decreased with stress and 97% developed new regional wall motion abnormalities in ≥4 segments. Peak wall motion score index was 1.65 ± 0.39. Midventricular (100%) and apical (87%) segments were most often involved with relative sparing of the basal segments (77%; p = 0.01). There were no deaths during follow-up (2.3 ± 0.7 years). In conclusion, the major findings of this study were that strongly false-positive SEs occurred predominantly in postmenopausal women, and frequently involved the apical and mid–left ventricular segments, features that were similar to ABS. Data were consistent with the hypothesis that some false-positive SEs may represent a forme fruste of ABS.

Section snippets

Methods

As previously described,10, 11 we prospectively identified all consecutive patients with (1) normal left ventricular systolic function at rest (no regional wall motion abnormalities at rest), (2) a markedly abnormal left ventricular response to stress, and (3) normal coronary arteries on an angiogram obtained within 30 days of the stress test from November 2003 to December 2006. A markedly abnormal left ventricular response to stress was defined as the presence of new regional wall motion

Results

During the 38 months of the study, 1,645 consecutive patients underwent stress echocardiography followed by coronary angiography within 30 days. Of these, 141 patients developed new regional wall motion abnormalities with stress and had angiographically normal coronary arteries. Eighty-seven patients were excluded because they had a decrease in left ventricular end-systolic size in response to stress and another 23 were excluded because they had regional wall motion abnormalities at rest.

Discussion

The major findings of this study were that markedly abnormal SEs in patients with normal left ventricular systolic function at rest and normal epicardial coronary arteries occurred predominantly (1) in postmenopausal women, (2) during exercise echocardiography, (3) in the absence of a hypertensive response, and (4) with more frequent involvement of the midventricular and apical segments compared with the basal segments of the left ventricle.

In the present study, only patients who had normal

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