A multivariate approach for interpreting treadmill exercise tests in coronary artery disease.

Abstract

To determine the value of a multivariate approach for the analysis of the treadmill exercise tolerance test (ETT), 237 patients referred for evaluation of chest pain who underwent a standard Bruce protocol ETT and coronary arteriography were studied. Predictive value of a positive ETT was 0.78 (43/55) using 1.0--1.9 mm ST segment depression criterion, 0.97 (59/61) using greater than or equal to 2.0 mm ST segment depression. When the 1.0--1.9 mm ST criterion was combined with peak systolic blood pressure-heart rate product (double product) less than or smaller than 23,000, exercise duration less than 6 minutes, and ST depression for greater than 3 minutes into recovery, predictive value improved to 0.89 in 18 patients with any two of the above. Predictive value for multivessel disease was also improved using non-ST criteria. Predictive value of a negative ETT for absence of coronary artery disease was 0.60 (29/48), and was 0.86 (12/14) if double product was greater than or equal to 30,000. Presence of chest pain during ETT did not improve predictive value of any type of test. Digitalis ingestion in 33 patients was not associated with decreased predictive value of a positive test. These data suggest that the predictive value of both positive and negative ETT in a symptomatic population can be improved with a multivariate approach.

Studies on ergometer exercise testing I. Significance of the type of st‐segment response, sex, and chest pain

“…During the follow-up, the incidence of coronary events in positive responders was 18% for men and only 5% for women. In arteriographically controlled studies the sensitivity of EECG (about 80%) did not differ between men and women though there was a trend that specificity was somewhat better in men (Berman et al, 1978;Detry et al, 1977;Sketch et al, 1975;Wiener et al, 1975). The prevalence of CAD in patients with chest pain is frequently reported to be higher in men than in women (Berman et (Wiener et a f .…”

Duplo produto elevado como preditor de ausência de coronariopatia obstrutiva de grau importante em pacientes com teste ergométrico positivo

“…However, Positive Likelihood Ratio was increased to 1,831, thus showing improvement in test accuracy. The fact that Berman et al 32 have increased negative predictive value of negative ET for the absence of CAD is most likely due to the lower probability of detecting signifi cant disease in tests with no ST segment changes (normal), or else, to the variety of populations under study for CAD prevalence.…”

“…Berman et al 32 were successful in managing to increase ET negative predictive value for the absence of CAD when RPP was higher than 30,000mmHg. bpm.…”

A comparison of treadmill scores to diagnose coronary artery disease

“…2,3 Several treadmill scores, which incorporate both clinical and test variables, have been proposed as useful tools in this regard. [4][5][6][7][8] The Duke Treadmill Score (DTS), traditionally a prognostic score, was recently tested as a diagnostic score and shown to predict CAD better than the ST response alone. 9 The American College of Cardiology/American Heart Association (ACC/AHA) guidelines on exercise testing suggest using computer-assisted treadmill scores to enhance the interpretation of the test.…”

“…20 With the advent of the computer age, several probabili-119 ty scores, created with multiple logistic regression analysis, have been described. [4][5][6][7][8] Detrano et al analyzed exercise data in over 3,000 patients from eight institutions and identified significant clinical and test characteristics which were applied to a computer algorithm (Detrano score, see appendix 1) for estimating the probability of any significant coronary obstruction. 6 In a test population of almost 400 patients from three institutions, this group found that the Detrano score was at least as accurate for diagnosing CAD as expert cardiac clinicians familiar with the clinical and exercise test data of the patients.…”