Comparison of a Quantitative Treadmill Exercise Score with Standard Electrocardiographic Criteria in Screening Asymptomatic Young Men for Coronary Artery Disease

Abstract

A computer-derived treadmill exercise score that quantifies the electrocardiographic response to exercise has been reported to have a high sensitivity (87 per cent) and specificity (92 per cent) in patients with a high prevalence of coronary artery disease. To test its accuracy in young, asymptomatic men with a low prevalence of coronary artery disease, we evaluated the responses of 377 military officers (mean age, 36.6 years) by two independent methods. According to standard electrocardiographic criteria, 45 of the subjects (12 per cent) had positive tests, whereas the treadmill exercise score indicated that only 3 (less than 1 per cent) had positive tests. Since two of these three had left ventricular hypertrophy and met only the criteria for the latter without associated coronary artery disease, the treadmill exercise score predicted that only 1 of 377 subjects would have clinically important coronary artery disease. Coronary arteriography, performed in 10 persons with the most positive scores on standard treadmill tests and the highest scores for risk factors, showed that nine subjects did not have coronary artery disease and that one had single-vessel disease (the same subject who the treadmill score predicted would have mild disease). The treadmill exercise score appears to improve the diagnostic specificity of exercise electrocardiography and may be more useful than values on standard stress tests in screening asymptomatic populations for coronary artery disease.

Exercise Electrocardiogram Testing

“…The rate-recovery loop has been found to be more useful than ST-depression criteria for the identification of restenosis after angioplasty. 92 Recovery phase and exercise phase ST behavior were incorporated by Hollenberg et al 58,59 into a treadmill exercise score that is adjusted for heart rate. A number of more recent studies have confirmed the diagnostic value of combining exercise and recovery phase ST-segment data in the heart rate domain.…”

“…Adjustment for R-wave amplitude improved the performance of the Hollenberg treadmill score. 58,59 Other studies have been less positive, including the finding of opposite directional changes. 60 Detrano et al 32 found that R-wave behavior with exercise alone had limited performance but that there was some diagnostic advantage in normalizing ST depression for R-wave amplitude.…”

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.…”

Current review of exercise testing: applicatiOn and interpretation

“…A modified version of this exercise score for asymptomatic individuals also has shown promise (Hollenberg et al, 1985).…”