Comparative Outcomes of Stress Echocardiography and CT Coronary Angiography in the Assessment of Suspected Coronary Artery Disease: A Pilot Study

Stress echocardiography (SE) detects myocardial ischemia while coronary computed tomography angiography (CCTA) detects structural abnormalities associated with coronary artery disease (CAD). A pilot retrospective study of 270 consecutive patients who underwent both SE and CCTA to explore which test is more accurate in patients with CAD. Health records and risk factors, SE, and CCTA outcomes were reviewed. SE outcomes were positive (n = 36) and negative (n = 234); CCTA outcomes were based on CAD severity (absent, mild, moderate, and severe). 219 (81.1%) patients had a positive CCTA, indicating the presence of CAD with mild, moderate, or severe stenosis. Despite a positive CCTA (n = 191), 70.7% had a negative SE. This discrepancy was most prevalent in the moderate CCTA category, where 110 patients had a negative SE but positive CCTA. Additionally, 9 patients demonstrated a positive SE despite no significant CCTA findings, indicating that functional abnormalities could have remained undetected by anatomical imaging. It is suggested that significant CAD detected by CCTA does not necessarily suggest myocardial ischemia, while the presence of myocardial ischemia is not necessarily associated with significant CAD, suggesting other causes (e.g., microvascular angina). A positive CCTA but negative SE findings may suggest the presence of coronary collaterals.