BACKGROUND: Stress echocardiography is a widely available and used imaging modality in the assessment of ischaemic heart disease (IHD) and preoperative risk stratification. Despite the higher rate of major adverse cardiovascular events (MACE) observed in positive stress echocardiography results, the prognostic relevance of a false-positive (FP) stress echocardiogram is unclear. METHODS: The authors searched Medline, Embase, CINAHL, Web of Science, The Cochrane Central Register of Controlled Trials, EBSCO Open Dissertation and Clinicaltrials.gov from inception to 15 April 2024, for studies evaluating the prognostic relevance of a FP stress echocardiogram response in patients with suspected or known IHD. Primary outcomes included the occurrence of MACE within the studied follow-up duration. Random effects meta-analysis was performed to evaluate the direction of effect and allow comparisons between FP, true-positive and true-negative stress echocardiography results. RESULTS: A total of five studies were included with 2426 patients (mean age 56-66 years, 60.2% males). In total, there were 737 (30.3%) FP stress echocardiogram results. MACE occurred in 274 participants, of which 79 (28.8%) occurred within the FP stress echocardiography group. Meta-analysis from three studies demonstrated more MACE outcomes in patients with a true positive in comparison to a FP stress echocardiography result (RR 1.64, 95% CI: 1.22 to 2.20). Two studies reported increased MACE outcomes in patients with a FP result when compared with a true negative result. CONCLUSIONS: An FP stress echocardiogram result is common and frequently associated with patients who have a low pre-test probability for IHD. FP results are not associated with increased incidence of MACE when compared with true positive results; however, there is insufficient evidence to establish whether FP results in dobutamine stress echocardiography identify a cohort of high-risk patients in comparison to true negative results. PROSPERO REGISTRATION NUMBER: CRD 42024526741.