Coronary computed tomography angiography, ECG stress test and nuclear imaging as sources of false-positive results in the detection of coronary artery disease.

The most important goal of a diagnostic test is to discriminate patients with from patients without disease. The accuracy of a diagnostic test is evaluated by comparing the results of a test with a ‘gold standard’, that is, with a test considered by most as the actual means to achieve an unequivocal diagnosis. In cardiology, invasive coronary angiography (ICA) has been usually deemed the means to diagnose coronary artery disease (CAD); however, apart from not being devoid of risks, ICA only depicts the anatomical severity of a coronary lesion, but cannot accurately identify its hemodynamic relevance, that is frequently confirmed with fractional flow reserve (FFR), as invasively assessed through the measurement of coronary pressure distal to the lesion after minimization of microvascular resistance – usually with adenosine intra venous infusion or intracoronary bolus. Therefore, there is a clinical need for accurate, noninvasive tests that would allow the making of a diagnosis in a simpler, noninvasive, less risky, and in a repeatable way.