Hemodynamic Characteristics of Patients with Coronary Artery Disease Presenting False-Negative Exercise Stress Test

Abstract

The present study was designed to clarify the characteristics of left ventricu lar hemodynamics and coronary arteries in patients with coronary artery dis ease presenting false-negative response to the Master's two-step stress test. Eighty-eight consecutive patients performed the Master's two-step stress test and had coronary angiography for evaluation of suspected or known coronary artery disease. The frequency of false-negative and true-positive responses in the Master's two-step stress test was 20% and 45%, respectively. Elevated left ventricular end-diastolic pressure, reduced ejection fraction, and low cardiac output characterized the left ventricular hemodynamics in patients with false- negative responses, as compared with those with true-positive response. The severity and extent of coronary artery disease, as well as prior myocardial in farction, did not affect the frequency of false-negative response. This study indicates that the false-negative response to the Master's two-step test is unexpectedly frequent in coronary artery disease with severe left ventric ular dysfunction. Thus, one should be careful in judging the results of the Mas ter's two-step test in symptomatic patients with severe left ventricular dysfunction.