Previous studies have found a suggestive clinical history to significantly bias interpretation of electrocardiograms among physicians (van den Berge). Multiple previous studies have shown that cognitive bias is associated with therapeutic or management errors (Saposnik).

Because stress echocardiography is a commonly used imaging modality to discriminate between cardiac and non-cardiac chest pain and has implications for patient management, features which may influence non-expert interpretation of stress echo is of clinical importance. Fortunately, the rate of discordance was low and the majority of cases with disagreement were due to a site positive result of ischemia with a core lab result of normal. While this may lead to an increased use of medical therapy and further testing, it is likely that functionally significant coronary artery disease is not being missed by non-expert sites. [Insert statement about specific variables that influenced discordance].