Current review of exercise testing: applicatiOn and interpretation

Abstract

Summary: Exercise testing has changed dramatically in scope over the past 50 years. While initially used to assess functional capacity, it is now also utilized to detect the presence and severity of coronary artery disease (CAD), to evaluate postmyocardial infarction patients at risk for future cardiac events, to screen certain asymptomatic populations for CAD, and to evaluate dysrhythmias, peripheral vascular disease, and lung disease. Dynamic exercise in continuous multistage protocols is most popularly employed because of the more easily measured workload. The safety of exercise testing, its contraindications and termination end points are summarized. The sensitivity of exercise testing ranges between 60 and 70% while specificity has been reported between 85 and 90%. Both sensitivity and specificity are enhanced through use of radionuclide exercise thallium imaging and ventricular angiography .

Exercise test predictors of severe coronary artery disease: Role of ST‐segment elevation in lead aVR

“…ST‐segment depression (STD) induced during an exercise stress test (EST) is considered the most valuable electrocardiographic (ECG) abnormality for the diagnosis of myocardial (subendocardial) ischemia, and therefore of obstructive coronary artery disease (CAD) …”

“…ST-segment depression (STD) induced during an exercise stress test (EST) is considered the most valuable electrocardiographic (ECG) abnormality for the diagnosis of myocardial (subendocardial) ischemia, and therefore of obstructive coronary artery disease (CAD). [1][2][3] Lead aVR is usually excluded from routine analysis of ESTinduced ST-segment changes. Due to its axis orientation (+210 ), indeed, aVR is believed to not explore any specific region of the heart and have poor association with myocardial ischemia.…”