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

Aaron M. From, Abhiram Prasad, Patricia A. Pellikka, Robert B. McCully

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)1434-1438
Number of pages5
JournalAmerican Journal of Cardiology
Volume103
Issue number10
DOIs
StatePublished - May 15 2009

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ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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