Comparison of the Double Two-Step Test and the Maximal Exercise Treadmill Test

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Abstract
A comparison of the double two-step test and a more strenuous type of exercise test was made to assess the value of the latter procedure in increasing the sensitivity of the electrocardiographic exercise test. In young, normal women, 17 to 20 years of age, who represent a group with minimal chances for significant silent coronary heart disease, both the double two-step test and graded maximal exercise tests were always normal. This is consistent with the view that ischemic electrocardiographic changes are not usually elicited in subjects with normal coronary circulation, even after strenuous exercise. In middle-aged men and women, 40 to 65 years of age, in whom the possible existence of clinically silent coronary heart disease was suggested by age and other parameters (atypical chest pain, hypertension, or diabetes, or all three), the maximal exercise test on the treadmill, as compared to the double two-step test, increased the yield of positive electrocardiographic results by 12%. These findings suggest that, in selected "coronary-prone" subjects on whom the double two-step test is negative, increasing the amount of exercise might be of value in the evaluation of the exercise test.