I had a stress echo and the results say images were technically difficult but no evidence of stress induced ischemia. what does images were technically difficult mean? does that mean i need them to repeat the test. the dr said it was normal. concenrd?

Technically: Difficult suggests anatomic artifacts or structures obscuring the view, typical for fat tissue. If the doctor cleared it in the context of your symptoms and other tests, that should be reassuring for you. If follow up was recommended with or without tests, that was not for having an abnormal test, but due to the need for surveillance given your overall medical history.