Drop-off in positivity rate of stress echocardiography based on regional wall motion abnormalities over the last three decades

  • Lauro Cortigiani
  • Pamela Ramirez
  • Maico Coltelli
  • Francesco Bovenzi
  • Eugenio PicanoEmail author
Original Paper


Previous studies have suggested a decline in positivity of stress cardiac imaging based on regional wall motion abnormalities (RWMA). To assess the rate of RWMA positivity of stress echocardiography (SE) over 3 decades in the same primary care SE lab. We retrospectively assessed the rate of SE positivity in 7626 SE tests (dipyridamole in 5053, dobutamine in 2496, exercise in 77) in consecutive patients with known or suspected coronary artery disease and /or heart failure who performed SE in a primary care referral center from April 1991 to May 2018. Starting April 2005, SE based on RWMA was complemented by assessment of coronary flow velocity reserve (CFVR) of the left anterior descending coronary artery. Starting October 2016, we added left ventricular contractile reserve (LVCR). Starting October 2016, we also added B-lines by lung ultrasound. There was a progressive decline over time in the rate of SE positivity based on RWMA from 24% (1991–1999) to 10% (2000–2009) down to 4% (2010–2018) (p < 0.0001). Positivity rate was 29% with CFVR, 16% with LVCR, and 12% with B-lines. Over three decades, we observed a dramatic decline in SE positivity rate based on classical RWMA. In the last decade, the positivity rate rose sharply thanks to the stepwise introduction of CFVR, LVCR and B-lines as additional positivity criteria in integrated quadruple SE.


Echocardiography Ischemia Pre-test probability Stress 



Coronary artery disease


Coronary flow velocity reserve


Left ventricular contractile reserve


Regional wall motion abnormalities


Stress echocardiography


Transthoracic echocardiography


Wall motion score index



This study was supported by Institutional funds of Institute of Clinical Physiology of National Research Council of Pisa.

Compliance with ethical standards

Conflict of interests

The authors declare that they have no conflict of interests.


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Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  1. 1.Cardiology DivisionSan Luca HospitalLuccaItaly
  2. 2.National Institute of Medical Sciences and Nutrition Salvador ZubiranMexico CityMexico
  3. 3.Department of Computer Science and TechnologyESTARPisaItaly
  4. 4.Institute of Clinical Physiology, Biomedicine DepartmentCNRPisaItaly

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