Use of a Prognostic Treadmill Score in Identifying Diagnostic Coronary Disease Subgroups

Shaw, Leslee J.; Peterson, Eric D.; Shaw, Linda K.; Kesler, Karen; DeLong, Elizabeth R.; Harrell, Frank E.; Muhlbaier, Lawrence H.; Mark, Daniel B.

doi:10.1161/01.cir.98.16.1622

Cited by 265 publications

(138 citation statements)

References 23 publications

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“…A standard Duke treadmill score was calculated in the remaining 342 subjects and defined as low (Ն5), moderate (Ϫ10 to 4), or high (ՅϪ11) risk. 19 Stress and rest SPECT images were acquired by use of a large-field-of-view rotating gamma camera equipped with a highresolution, parallel-hole collimator. 2,16 Images were computer quantified and displayed as polar maps by an experienced investigator (J.J.M.)…”

Section: Spect Studymentioning

confidence: 99%

“…21,22 These tests, however, remain the cornerstone for evaluating risk in symptomatic patients with known or suspected CAD. [1][2][3][4][5][6]19 Detection of subclinical CAD seems desirable, particularly in view of recent primary prevention trials demonstrating that aggressive risk factor modification, including treatment of hyperlipidemia, reduces the incidence of subsequent cardiac events. 9,23,24 Moreover, many asymptomatic individuals with subclinical CAD die suddenly 25 and would not have been identified with ETT or SPECT.…”

Section: He Et Al Ebct and Silent Myocardial Ischemia 249mentioning

confidence: 99%

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Severity of Coronary Artery Calcification by Electron Beam Computed Tomography Predicts Silent Myocardial Ischemia

et al. 2000

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Background-Detection of subclinical coronary artery disease (CAD) before the development of life-threatening cardiac complications has great potential clinical relevance. Electron beam computed tomography (EBCT) is currently the only noninvasive test that can detect CAD in all stages of its development and thus has the potential to be an excellent screening technique for identifying asymptomatic subjects with underlying myocardial ischemia. Methods and Results-Over 2.5 years, we prospectively studied 3895 generally asymptomatic subjects with EBCT, 411 of whom had stress myocardial perfusion tomography (SPECT) within a close (median, 17 days) time period. SPECT and exercise treadmill results were compared with the coronary artery calcium score (CACS) as assessed by EBCT. The total CACS identified a population at high risk for having myocardial ischemia by SPECT although only a minority of subjects (22%) with an abnormal EBCT had an abnormal SPECT. No subject with CACS Ͻ10 had an abnormal SPECT compared with 2.6% of those with scores from 11 to 100, 11.3% of those with scores from 101 to 399, and 46% of those with scores Ն400 (PϽ0.0001). CACS predicted an abnormal SPECT regardless of subject age or sex. Conclusions-CACS

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Section: Spect Studymentioning

confidence: 99%

Section: He Et Al Ebct and Silent Myocardial Ischemia 249mentioning

confidence: 99%

Severity of Coronary Artery Calcification by Electron Beam Computed Tomography Predicts Silent Myocardial Ischemia

et al. 2000

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“…2,3,11 However, the shortcomings of ST-segment analysis may reflect the limitations of using a single cutoff of ST-segment depression, and this may be addressed by assessment of ST segment as a continuous variable, for example using the ST/heart-rate slope 12 or a multivariate score such as the Duke treadmill score. 13,14 Myocardial perfusion imaging may also present inaccuracies because of false-positive and negative results caused by disturbed coronary flow reserve, partial volume issues, and reduced exercise capacity, 15,16 although there are reports of more favorable accuracy. 17 The definitive study for the comparison of stress echocardiography with single-photon emission computed tomography (SPECT) was reported by Fragasso, 1 who compared dobutamine stress echocardiography with dipyridamole stress 99 mTc-MIBI stress/rest myo- Figure 3.…”

Section: Assessment Of Cad In Patients With Hypertension and LV Hypermentioning

confidence: 99%

Prediction of Outcomes in Hypertensive Patients With Suspected Coronary Disease

et al. 2002

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Abstract-Stress echocardiography has been shown to improve the diagnosis of coronary artery disease in the presence of hypertension, but its value in prognostic evaluation is unclear. We sought to determine whether stress echocardiography could be used to predict mortality in 2363 patients with hypertension, who were followed for up to 10 years (mean 4.0Ϯ1.8) for death and revascularization. Stress echocardiograms were normal in 1483 patients (63%), 16% had resting left ventricular (LV) dysfunction alone, and 21% had ischemia. Abnormalities were confined to one territory in 489 patients (21%) and to multiple territories in 365 patients (15%). Cardiac death was less frequent among the patients able to exercise than among those undergoing dobutamine echocardiography (4% versus 7%, PϽ0.001). The risk of death in patients with a negative stress echocardiogram was Ͻ1% per year. Ischemia identified by stress echocardiography was an independent predictor of mortality in those able to exercise (hazard ratio 2.21, 95% confidence intervals 1.10 to 4.43, Pϭ0.0001) as well as those undergoing dobutamine echo (hazard ratio 2.39, 95% confidence intervals 1.53 to 3.75, Pϭ0.0001); other predictors were age, heart failure, resting LV dysfunction, and the Duke treadmill score. In stepwise models replicating the sequence of clinical evaluation, the results of stress echocardiography added prognostic power to models based on clinical and stress-testing variables. Thus, the results of stress echocardiography are an independent predictor of cardiac death in hypertensive patients with known or suspected coronary artery disease, incremental to clinical risks and exercise results.

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“…11 -14 This is illustrated by the Duke Treadmill Score which has exercise duration as its initial variable, such that a person exercising less than 5 min (∼ 6 METS) on a Bruce protocol, even without ECG changes or anginal symptoms, is at increased risk. 15 Although poor exercise capacity is recognized as an adverse prognostic element, studies which have examined the sensitivity of ETT for the diagnosis of CAD have used the criterion of 85% MPHR as an "adequate" test even if the patient has not exercised beyond 5 METS. 3,4,9 These patients, in general, are deconditioned and achieve their target heart rate in a short period of time.…”

Section: Prognostic Value Of the Exercise Treadmill Testingmentioning

confidence: 99%

In Search of the False‐negative Exercise Treadmill Testing Evidence‐based Use of Exercise Echocardiography

Southard

Baker

Schaefer

2008

Clinical Cardiology

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SummaryBackground: Controversy exists regarding the role of exercise treadmill testing (ETT) versus exercise stress echocardiography (ESE) as the appropriate initial noninvasive test to risk-stratify patients with chest pain. The majority of studies to date that evaluated these methodologies included patients with poor functional status and baseline electrocardiogram (ECG) abnormalities, potentially limiting the sensitivity of ETT.Hypothesis: We examined the hypothesis that given stringent standards of exercise duration and ECG interpretability, the ETT would have a high diagnostic sensitivity for the presence of significant coronary artery disease (CAD).Methods: Results of concurrent ETT and ESE in 3,098 patients were examined, and the subset of patients with a negative ETT and positive ESE (−ETT/+ESE) were reviewed for the presence of CAD as a function of exercise duration (< or ≥ 6 min) and baseline ECG normality.Results: In those patients with a −ETT/+ESE who exercised ≥ 6 min, 54 had a normal baseline ECG, 22 underwent angiography and 6 had CAD (all of whom had either small, grafted or collateralized vessels). Patients with a −ETT/+ESE who were incapable of exercising 6 min were more frequently older and female. Mortality was significantly greater in the < 6 min exercise duration group (31.4 versus 3.1%).

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Use of a Prognostic Treadmill Score in Identifying Diagnostic Coronary Disease Subgroups

Cited by 265 publications

References 23 publications

Severity of Coronary Artery Calcification by Electron Beam Computed Tomography Predicts Silent Myocardial Ischemia

Severity of Coronary Artery Calcification by Electron Beam Computed Tomography Predicts Silent Myocardial Ischemia

Prediction of Outcomes in Hypertensive Patients With Suspected Coronary Disease

In Search of the False‐negative Exercise Treadmill Testing Evidence‐based Use of Exercise Echocardiography

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