The Uses and Limits of Standard Exercise Tests

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Abstract
• Standard exercise electrocardiography to detect coronary artery disease involves limitations of accuracy in a population of apparently healthy persons, to the extent that its value for counseling such individuals is doubtful. Among subjects being examined for chest pain, however, the accuracy of the exercise ECG in predicting coronary obstructive disease is better. In addition, the presence of more severe coronary obstructive disease tends to be associated with more distinctly abnormal tests at low levels of exercise. This tendency of association between marked ST-segment displacement at low exertion levels and more severe obstructive disease adds a measure of prognostic value to the standard exercise ECG in persons with chest pain or after myocardial infarction. The addition of either isotopic cardiac imaging or coronary arteriography to exercise ECG will be appropriate for situations in which either the ECG is known to be nonspecific or inadequate exercise is achieved. (Arch Intern Med 141:229-232, 1981)