The role of the exercise test in the evaluation of patients for ischemic heart disease.

Abstract

A cohort of 1472 patients who underwent both exercise stress testing and coronary angiography within six weeks was examined. The data indicated that a combination of exercise parameters is both diagnostically and prognostically important. Almost all patients (greater than 97%) who had positive exercise tests at Stage I or Stage II had significant coronary artery disease. More than half of these (greater than 60%) had three vessel disease and over 25% had significant narrowing (greater than 50%) of the left main coronary artery. Patients who achieved Stage IV or greater exercise durations with either negative or indeterminate ST-segment response had less than a 15% prevalence of three vessel disease and less than a 1% prevalence of left main coronary artery disease. A low risk subgroup (75% of all non-operated patients) was identified with a twelve month survival greater than 99%. A high risk subgroup (11% of all nonoperated patients) was identified with a twelve month survival of less than 85%. The exercise test is a noninvasive, reproducible method to assess the presence and extent of anatomic disease and the prognosis when significant disease has been defined. It should be used in conjunction with other noninvasive tests to determine optimal management in patients evaluated for ischemic heart disease.

Significance of the negative exercise test in evaluation of patients with chest pain

“…of three vessel disease and 3 lI~ of left main disease among patients with negative exercise tests referred for the evaluation of possible coronary heart disease (13). The percentage of false negative tests in these series is 40o/c (present study) 35 'Ii (10), and 43",( (13). These data indicate that the negative exercise test has little value in excluding coronary heart disease in symptomatic patients.…”

“…McNeer et al have reported a prevalence of 14 lie. of three vessel disease and 3 lI~ of left main disease among patients with negative exercise tests referred for the evaluation of possible coronary heart disease (13). The percentage of false negative tests in these series is 40o/c (present study) 35 'Ii (10), and 43",( (13).…”

Stratification of single-vessel coronary stenosis by ischemic threshold at the onset of wall motion abnormality during continuous monitoring of left ventricular function by semisupine exercise echocardiography

“…15 Despite the good agreement between exercise tests and clinical follow-up, the correlation between exercise electrocardiography and coronary angiography has been poor. 3,16 Indeed, ST-segment depression as assessed by electrocardiography represents a relatively insensitive marker of myocardial ischemia. 1,2 Several studies have shown a poor relation between the heart rate at the point of induction of WMA and at the onset of significant ST-segment depression during stress Figure 3 Receiver-operator characteristic curves for diagnostic accuracy of percent diameter stenosis and minimal lumen diameter for occurrence of exercise-induced wall motion abnormality on echocardiography.…”

“…[1][2][3] Consequently, the relation between the ischemic threshold assessed by electrocardiographic changes during exercise and coronary arteriography has been poorer than expected. 3 Exercise echocardiography (EE) is an accepted tool for the assessment of the functional significance of coronary obstructions among patients with coronary artery disease (CAD).…”

“…[1][2][3] Consequently, the relation between the ischemic threshold assessed by electrocardiographic changes during exercise and coronary arteriography has been poorer than expected. 3 Exercise echocardiography (EE) is an accepted tool for the assessment of the functional significance of coronary obstructions among patients with coronary artery disease (CAD). [4][5][6][7][8] In previous reports, the classification of CAD has been mostly semiquantitative, assessed by visual analysis, or based on predetermined cutoff values of angiographic parameters.…”