Confused on Stress Echo results, please help.

[ratman4]

37-year-old Male. Non-Smoker, normal weight,family history unknown. Recent PVC's so went to doc did EKG that came back abnormal. Referred to a respected cardio in the area.

Cardio did EKG that again was abnormal so he ordered Stress Echo. I exercised for 11 minutes with no symptoms. Results:
Chamber sizes normal, no hypertrophy. LV function is normal however there is classic MVP. No effusion, mass, or thrombus. With exercise there is septal and distal inferior atypical motion and slight hypokinesis, with other segments augmenting. The overall ejection fraction rises.

Impression: Clinical (Nonischemic), EKG Response (Nonischemic), Echo Response (Ischemic). Conclusion: Exercised well but has distinct MVP. Wall motion at rest is normal, but there are Septal and Inferior wall motion abnormalities at peak exercise.

Cardio said something about Bays Theorem? Ordered Stress MPI ASAP. Results as follows:Patient exercised for 12:00 achieved 97% of PMR. No chest discomfort noted. ECG revealed normal sinus without ST or T wave changes.

Nuclear Analysis: Rest and post stress images appear normal. No perfusion abnormalities are identified.

Gated Analysis: Gated images done to evaluate resting perfusion abnormalities to correlate wall motion. No wall motion abnormalities were identified. Clinical, EKG and Nuclear Response: Non-Ischemic.

Cardio said results made more sense everything looked good. Said Stress MPI more sensitive than S-Echo.

Is my heart really okay? Should I be concerned about the findings of the Stress Echo? Please, please give me your thoughts.

[Cleveland Clinic]

ratman,

thanks for the post.

Stress testing is a noninvasive method to screen for coronary
disease and significant blockages from coronary disease.
However, there can be false positive and false negative test. The pretest probablity of a patient having coronary disease can influence the probablity of a fale positive or negative result. For example, a positive stress test in an 18 year old girl is most likely a false positive since her likelyhood of disease is low.  Your likelyhood of disease is pretty low to start (both because of your demographics, and beacuse of your ecg and exercise response (which was quite good) on the stress) so your cardiologist was concerned that the echo results were a false positive and ordered a different noninvasive stress test instead of exposing you to the risk of a cardiac catheterization.  

Is my heart really okay? Should I be concerned about the findings of the Stress Echo? Please, please give me your thoughts.

Sounds like your cardiologist is on the right track.

good luck

[Mike051573]

That has me now wondering if the stress test I had was not a "true reading" (lol - oh no and also see my post I just recently did on "palpitations after exercise" - its a lengthy one).
  Yet my echo results came back ok and with no structural defects yet now im thinking I should have all my previous tests redone over again :(
  Oh well hey and the best luck to you and hope you get better....

- Mike

[ratman4]

Thank you for the reply, it was very helpful. I am wondering about the "false positive" portion of the stress echo though. Isn't someone (Doctor) actually looking at the wall motion and diagnosing it as abnormal with their own eyes? If so, in the case of false positives, are they just misdiagnosing what they are looking at?

[EchoTech]

It would be pointless to do the tests over again.  Your heart is healthy if you have essentially two negative tests.  The stress echo wall motion was hard to determine for one reason or another so you did the nuc and it turned out fine.  There is no ischemia so that makes the echo a false positive, but that doesn't mean all the information in the test is useless.  There is no 100% right all the time test.  This is why if there is a question, they do multiple tests to make sure.

Ratman
  The doctor is indeed looking at the images, but there is no 100% right all the time test like I said above.  In false positives, the pictures look like they are (for example) showing  a bad wall motion, but it is not when looked at through another test.    We strive to do our best to prevent them, but it is just in the nature of the testing to give false positives.  We don't want to subject you to any more testing than you have to have.  Each test has it's own risks and we try to minimize them as much as possible. I hope this helps the both of you.