Applicability and Interpretation of Electrocardiographic Stress Testing in Patients with Peripheral Vascular Disease

ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery

“…The risk of perioperative cardiac events and long-term risk are increased significantly in patients with an abnormal exercise ECG at low workloads. 184,177,178 In contrast to the above-mentioned studies of patients with vascular disease, in a general population of patients in which only 20% to 35% had peripheral vascular disease and who were undergoing noncardiac surgery, Carliner et al 186 reported exercise-induced ST-segment depression greater than or equal to 1 mm in 16% of 200 patients older than 40 years (mean age 59 years) being considered for elective surgery. Only 2 patients (1%) had a markedly abnormal (ST-segment depression of 2 mm or more) exercise test.…”

“…177 The frequency of an abnormal exercise ECG response is dependent on prior clinical history. 177,180 Among patients without a cardiac history and with a normal resting ECG, approximately 20% to 50% will have an abnormal exercise ECG. The frequency is greater (35% to 50%) in patients with a prior history of MI or an abnormal rest ECG.…”

Minimising cardiac anaesthetic risk: the tortoise or the hare?

“…Exercise electrocardiography enables assessment of the functional status of the coronary circulation. In separate studies both Cutler et al and Arous et al have shown that a negative exercise study, after achieving a target heart rate-pressure product, was associated with low risk [33,341. Exercise inducible myocardial ischaemia suggested an increased risk of postoperative cardiac morbidity and mortality.…”

2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery

“…The risk of perioperative cardiac events and long-term risk are increased significantly in patients with an abnormal exercise ECG at low workloads. 176,178,179 In contrast to the above-mentioned studies of patients with vascular disease, in a general population of patients in which only 20% to 35% had peripheral vascular disease and who were undergoing noncardiac surgery, Carliner et al 185 reported exercise-induced ST-segment depression greater than or equal to 1 mm in 16% of 200 patients older than 40 years (mean age 59 years) being considered for elective surgery. Only 2 patients (1%) had a markedly abnormal (ST-segment depression of 2 mm or more) exercise test.…”

“…178 The frequency of an abnormal exercise ECG response is dependent on prior clinical history. 178,181 Among patients without a cardiac history and with a normal resting ECG, approximately 20% to 50% will have an abnormal exercise ECG. The frequency is greater (35% to 50%) in patients with a prior history of MI or an abnormal rest ECG.…”