Exercise Electrocardiography in the Asymptomatic Patient
Part of the
Developments in Cardiovascular Medicine
book series (DICM, volume 235)
Exercise electrocardiography (exercise ECG) is the cornerstone of evaluation for the presence of coronary artery disease when the initial history indicates that further assessment is indicated. This testing method combines the attributes of good predictive accuracy, easy availability, and relatively low cost. As with all testing modalities, however, its results are imperfect. Thus, understanding the principles of test interpretation in the context of the specific patient being tested is essential.
KeywordsCholesterol Fatigue Depression Ischemia Beach
Laslett LJ, Amsterdam EA, Mason DT. Evaluating the positive exercise test in the asymptomatic individual. Chest
Laslett LJ, Amsterdam EA. Management of the asymptomatic patient with an abnormal exercise ECG. JAMA.
1984; 252:1744–1746.PubMedCrossRefGoogle Scholar
Rifkin RD, Hood WB Jr. Bayesian analysis of electrocardiographic exercise stress testing. N Engl J Med.
; 297:681–687.PubMedCrossRefGoogle Scholar
Jones RJ. Bayes’ theorem, the exercise ECG, and coronary artery disease. JAMA.
Diamond GA, Forrester JS. Analysis of probability as an aid in the clinical diagnosis of coronary artery disease. N Engl JMed.
1979; 300:1350–1358.CrossRefGoogle Scholar
Epstein SE. Implications of probability analysis on the strategy used for non-invasive detection of coronary artery disease. Am J Cardiol.
1980; 46:491–499.PubMedCrossRefGoogle Scholar
Bayes T. An essay toward solving a problem in the doctrine of chance. Philos Trans R Soc London.
1763; 53: 370.CrossRefGoogle Scholar
Kuller LH, Shemanski L, Psaty BM, et al. Subclinical disease as an independent risk factor for cardiovscular disease. Circulation.
1995; 92: 720–726.Google Scholar
Goldschlager H, Selzer Cohn K. Treadmill stress tests as indicators of presence and severity of coronary artery disease. Ann Intern Med.
1976; 85:277–286.PubMedGoogle Scholar
McNeer JF, Margolis JR, Lee KL, et al. The role of the exercise test in the evaluation of patients for ischemic heart disease. Circulation.
1978; 57:64–70.PubMedCrossRefGoogle Scholar
Weiner DA, Ryan TJ, McCabe CH, et al. Prognostic importance of a clinical profile and exercise test in medically treated patients with coronary artery disease. J Am Coll Cardiol
. 1984; 3:772–779.PubMedCrossRefGoogle Scholar
Ellestad MH, Thomas L
, Ong R, et al. The predictive value of the time course of ST depression during exercise testing in patients referred for angiograms. Am Heart J
. 1992; 123;904–908.PubMedCrossRefGoogle Scholar
Ellestad MH, Halliday WK. Stress testing in the management of ischemic heart disease. Angiology.
1977; 28:149–159.PubMedCrossRefGoogle Scholar
Ekelund LG, Suchindran CM, McMahon RP, et al. Coronary heart disease morbidity and mortality in hypercholesterolemic men predicted from an exercise test: the Lipid Research Clinics Coronary Primary Prevention Tial. J Am Coll Cardiol.
1989; 14:556563.Google Scholar
Pupila G, Mattei O, Mazzara D, et al. Reproducibility and relation to the degree of myocardial ischemia of postexercise electrocardiographic changes in stable angina pectoris. Am J Cardiol 1991; 68:1397–1400.CrossRefGoogle Scholar
Callaham PR, Thomas L, Ellestad MH. Prolonged ST-segment depression following exercise predicts significant proximal left coronary artery stenosis. Circulation.
1987; 76(suppl 1V):253. Abstract.Google Scholar
Ellestad MH. ECG patterns and their significance. In: Ellestad MH,ed. Stress Testing Principles and Practice.
Philadelphia, PA: F A Davis; 1996.Google Scholar
Longhurst JC, Kraus WL. Exercise-induced ST elevation in patients without myocardial infarction. Circulation.
1979; 60: 616–629.PubMedCrossRefGoogle Scholar
, Sriwattanakomen S, Ticzon AR, Lubritzky SA, et al. ST segment elevation during exercise: Electroncardiographic and arteriographic correlation in 38 patients. Am J Cardiiol.
1980; 45:762–768.CrossRefGoogle Scholar
Dunn RF, Freedman B, Kelly DT, et al. Exercise-induced ST-segment elevation in leads VI or AVL. A predictor of anterior myocardial ischemia and left anterior descending coronary artery disease. Circulation.
1981; 63:1357–1363.PubMedCrossRefGoogle Scholar
Weiner DA, McCabe CH, Cutler SS, et al. Decrease in systolic blood pressure during exercise testing: Reproducibility, response to coronary bypass surgery and prognostic sigui fiicance. Am J Cardiol.
1982; 49:1627–1631.PubMedCrossRefGoogle Scholar
Hammermeister KE, DeRouen TA, Dodge HT, et al. Prognostic and predictive value of exertiionai hypotension in suspected coronary heart disease. Am J Cardiol.
1983; 51: 1261–1265.PubMedCrossRefGoogle Scholar
Dubach P, Froelicher VF, Klein J.
Exercise-induced hypotension in a male population. Circulation.
1988; 78:1380-I387.PubMedCrossRefGoogle Scholar
Morris CK, IJeshima K, Kawaguchi T, et al. The prognostic value of exercise capacity: a review of the literature, Am Heart J.
1991; 122;1423–1431.PubMedCrossRefGoogle Scholar
Mark DB, Hlatky MA, Harrell FE Jr, et al. Exercise treadmill score for predicting prognosis in coronary artery disease. Ann Intern Med.
1987; 106:793–800.PubMedGoogle Scholar
Mark DB, Shaw L, Harrell FE Jr, et al. Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. NEngl JMed.
1991; 325: 849–853.CrossRefGoogle Scholar
Monow K, Morris CK, Froelicher VF, et al. Prediction of cardiovascular death in men undergoing ininvasive evaluation for CAD. Ann Intern Med.
1993; 118: 689–695.Google Scholar
Weintraub WS, Madeira SW Jr, Bodenheimer MM, et al. Critical analysis of the application of Bayes’ theorem to sequential testing in the noninvasive diagnosis of coronary artery disease. Am J Cordial.
Weiner DA, Ryan TJ, McCabe CH, et al. Correlations among history of angina, ST-segment response and prevalence of coronary-artery disease in the Coronary Artery Surgery Study (CASS). N Engl JMed.
1979; 301:230–235.CrossRefGoogle Scholar
Hung J, Chaitman BR, Lam J, et al. Noninvasive diagnostic test choices for the evaluation of coronary artery disease in women. JAm Coll Cordial
. 1984; 4: 8–16.Google Scholar
Amsterdam EA, Price JE, Chin R, et al. Exercise stress testing in patients with angiographically normal coronary arteries: Similar frequency of false positive ischemic responses in males and females. American Journal of Cardiology.
1978; 41:378. Abstract.CrossRefGoogle Scholar
Gibbons RI, Balady GJ, Beasley.1W, et al. ACC/AHA Guidelines for Exercise Testing. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). J Am Loll Cordial.
1997; 30:260–311.Google Scholar
RA, Fisher LD, Ilossack KF. Validation of exercise enhanced risk assessment of coronary heart disease events: Longitudinal changes in incidence in Seattle community practice. JAm Coll Cardiol.
1985; 5:875–881.CrossRefGoogle Scholar
Multiple Risk Factor Intervention Research Group. Exercise electrocardiogram and coronary heart disease mortality in the Multiple Risk Factor Intervention Trial. Am J Cardiol
, 1985; 55:16–24.CrossRefGoogle Scholar
Rautaharju PM, Prineas RI, Eifler WJ, et al. Prognostic value of exercise electrocardiogram in men at high risk of future coronary heart disease: Multiple Risk Factor Intervention Trial experience. J Am Coll Cordial.
1986; 8: 1–10.Google Scholar
Gordon DJ, Ekelund LO, Karon JM, et al. Predictive value of the exercise tolerance test for mortality in North American men: The Lipid Research Clinics Mortality Follow-Up Study. Circulation
, 1986; 74:252–261.PubMedCrossRefGoogle Scholar
© Springer Science+Business Media New York 2002