Exercise testing in the evaluation of coronary artery disease - PubMed

• PMID: 6979501

Exercise testing in the evaluation of coronary artery disease

M H Ellestad et al. Herz. 1982 Apr.

Abstract

Exercise testing, after having established the indication (Tables 1 and 2) is not only an important method for detection of coronary artery disease, it also enables delineation of exercise capacity and permits assessment of medical and surgical treatment. A subnormal increase in heart rate or blood pressure, or even a decrease in blood pressure, during exercise may frequently be found in patients with known coronary artery disease or in those at high risk of developing subsequent coronary events. Downsloping ST segment depression is highly specific for the presence of coronary artery disease; the specificity of upsloping ST segment depression can be increased on requiring this pattern to consist of a 2 mm depression 0.08 s beyond the J point. Consideration of the QTc interval may also be useful in patients with upsloping ST segment depression. Marked ST segment depression and early onset of ST segment depression during exercise is related to increasing severity of the disease while the duration of ST segment depression bears no certain relevance. ST segment elevation may be associated with transmural myocardial ischemia, left ventricular aneurysm or variant angina. An increase in the R wave amplitude appears indicative of multiple vessel disease, while a reduction in septal Q wave amplitude is suggestive of left anterior descending coronary artery occlusion. The current concept of testing asymptomatic patients for coronary artery disease has low predictive value. Post-myocardial infarction exercise testing is an objective method for evaluation of prognosis and guiding management. In the assessment of the results of aorto-coronary bypass surgery, the finding of persistent angina and/or ST segment depression during exercise is indicative of residual ischemia; normalization of the exercise ECG in the presence of a high-level exercise capacity is usually associated with good coronary perfusion. In order to provide maximum diagnostic utility, exercise testing must take into consideration other clinical findings as well as the prevalence of disease in the respective population. With respect to the coronary angiographic findings as well as the incidence of coronary events, the predictive value of exercise testing may be notably increased on consideration of multiple clinical and exercise variables. The exercise test has evolved into a clinically important noninvasive method for the evaluation of the functional aspects of the heart.

Similar articles

• Diagnostic and prognostic value of exercise electrocardiography for coronary artery disease.

  Aronow WS. Aronow WS. Compr Ther. 1989 Nov;15(11):20-6. Compr Ther. 1989. PMID: 2684480 Review.

• [The exercise test with atropine].

  Variola A, Albiero R, Dander B, Buonanno C. Variola A, et al. G Ital Cardiol. 1997 Mar;27(3):255-62. G Ital Cardiol. 1997. PMID: 9244727 Clinical Trial. Italian.

• [The electrocardiogram during physical stress and Holter monitoring in the detection of asymptomatic myocardial infarct].

  Damjanović MM. Damjanović MM. Srp Arh Celok Lek. 1997 Nov-Dec;125(11-12):340-4. Srp Arh Celok Lek. 1997. PMID: 9480567 Serbian.

• Influence of coronary lesions morphology on treadmill exercise stress testing after acute myocardial infarction.

  Galrinho A, Ferreira R, Serra J, Rosário L, Oliveira M, Antunes E, Quininha J, Ferreira M, Antunes AM. Galrinho A, et al. Rev Port Cardiol. 1996 Mar;15(3):217-22, 181-2. Rev Port Cardiol. 1996. PMID: 8634170

• Silent myocardial ischemia: diagnosis, clinical significance and management.

  Stern S, Tzivoni D. Stern S, et al. Herz. 1987 Oct;12(5):318-27. Herz. 1987. PMID: 3315917 Review.

MeSH terms