Comparison of Submaximal Exercise ECG Test with Coronary Cineangiocardiogram
01 May 1970-Annals of Internal Medicine (American College of Physicians)-Vol. 72, Iss: 5, pp 641-646
TL;DR: Coronary arteriograms and submaximal exercise tests were compared in 100 patients, all of whom had chest pain, and forty-six patients were free of hypertension, aortic valve disease, or both.
Abstract: Coronary arteriograms and submaximal exercise tests were compared in 100 patients, all of whom had chest pain. Forty-six of these patients were free of hypertension, aortic valve disease o...
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TL;DR: This work reviewed the literature to estimate the pretest likelihood of disease and the sensitivity and specificity of four diagnostic tests and integrates fundamental pretest clinical descriptors with many varying test results to summarize reproducibly and meaningfully the probability of angiographic coronary-artery disease.
Abstract: The diagnosis of coronary-artery disease has become increasingly complex. Many different results, obtained from tests with substantial imperfections, must be integrated into a diagnostic conclusion about the probability of disease in a given patient. To approach this problem in a practical manner, we reviewed the literature to estimate the pretest likelihood of disease (defined by age, sex and symptoms) and the sensitivity and specificity of four diagnostic tests: stress electrocardiography, cardiokymography, thallium scintigraphy and cardiac fluoroscopy. With this information, test results can be analyzed by use of Bayes' theorem of conditional probability. This approach has several advantages. It pools the diagnostic experience of many physicians and integrates fundamental pretest clinical descriptors with many varying test results to summarize reproducibly and meaningfully the probability of angiographic coronary-artery disease. This approach also aids, but does not replace, the physician's ju...
2,515 citations
01 Jan 2002
TL;DR: The 10 major areas of change reflected in the update are described in a format that can be read and understood as a stand-alone document and are referred to the full-length Internet version to completely understand the context of these changes.
1,138 citations
TL;DR: Meta-analysis of reports comparing exercise-induced ST depression with coronary angiography found wide variability in the reported accuracy of the exercise electrocardiogram, not explained by information reported in the medical literature.
Abstract: To evaluate the variability in the reported diagnostic accuracy of the exercise electrocardiogram, we applied meta-analysis to 147 consecutively published reports comparing exercise-induced ST depression with coronary angiography. These reports involved 24,074 patients who underwent both tests. Population characteristics and technical and methodologic factors, including publication year, number of electrocardiographic leads, exercise protocol, use of hyperventilation, definition of an abnormal ST response, exclusion of certain subgroups, and blinding of test interpretation were analyzed. Wide variability in sensitivity and specificity was found (mean sensitivity, 68%; range, 23-100%; SD, 16%; and mean specificity, 77%; range, 17-100%; SD, 17%). The four study characteristics found to be significantly and independently related to sensitivity were the treatment of equivocal test results, comparison with a "better" test such as thallium scintigraphy, exclusion of patients on digitalis, and publication year. The four variables found to be significantly and independently related to specificity were the treatment of upsloping ST depressions, the exclusion of subjects with prior infarction or left bundle branch block, and the use of preexercise hyperventilation. Stepwise linear regression explained less than 35% of the variance in sensitivities and specificities reported in the 147 publications. There is wide variability in the reported accuracy of the exercise electrocardiogram. This variability is not explained by information reported in the medical literature.
813 citations
TL;DR: The ability of stress testing to predict coronary-artery disease is limited in a heterogeneous population in which the prevalence of disease can be estimated through classificat...
Abstract: To determine to what extent the diagnostic accuracy of stress testing is influenced by the prevalence of coronary-artery disease, we correlated the description of chest pain, the result of stress testing and the results of coronary arteriography in 1465 men and 580 women from a multicentered clinical trial. The pre-test risk (prevalence of coronary-artery disease) varied from 7 to 87 per cent, depending on sex and classification of chest pain. A positive stress test increased the pre-test risk by only 6 to 20 per cent, whereas a negative test decreased the risk by only 2 to 28 per cent. Aothough the percentage of false-positive results differed between men and women (12 +/- 1 per cent versus 53 +/- 3 per cent P less than 0.001), this difference was not seen in a subgroup matched for prevalence of coronary-artery disease. We conclude that the ability of stress testing to predict coronary-artery disease is limited in a heterogeneous population in which the prevalence of disease can be estimated through classification of chest pain and the sex of the patient.
548 citations
TL;DR: The exercise test is a nonin invasive, reproducible method to assess the presence and extent of anatomic disease and the prognosis when significant disease has been defined and should be used in conjunction with other noninvasive tests to determine optimal management in patients evaluated for ischemic heart disease.
Abstract: A cohort of 1472 patients who underwent both exercise stress testing and coronary angiography within six weeks was examined. The data indicated that a combination of exercise parameters is both diagnostically and prognostically important. Almost all patients (greater than 97%) who had positive exercise tests at Stage I or Stage II had significant coronary artery disease. More than half of these (greater than 60%) had three vessel disease and over 25% had significant narrowing (greater than 50%) of the left main coronary artery. Patients who achieved Stage IV or greater exercise durations with either negative or indeterminate ST-segment response had less than a 15% prevalence of three vessel disease and less than a 1% prevalence of left main coronary artery disease. A low risk subgroup (75% of all non-operated patients) was identified with a twelve month survival greater than 99%. A high risk subgroup (11% of all nonoperated patients) was identified with a twelve month survival of less than 85%. The exercise test is a noninvasive, reproducible method to assess the presence and extent of anatomic disease and the prognosis when significant disease has been defined. It should be used in conjunction with other noninvasive tests to determine optimal management in patients evaluated for ischemic heart disease.
476 citations
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1,363 citations
TL;DR: The various methods and concepts within health psychology that have been applied to further understanding of the factors that contribute to CHD and the various prevention and intervention strategies used to reduce the risk of CHD morbidity and mortality are illustrated.
Abstract: Despite considerable advances in research and practice over the past three decades, cardiovascular disease and, in particular, coronary heart disease (CHD) remains the primary cause of premature death in the United States. This chapter will illustrate the various methods and concepts within health psychology that have been applied to further our understanding of the factors that contribute to CHD and the various prevention and intervention strategies used to reduce the risk of CHD morbidity and mortality. This chapter will first provide an overview of etiological considerations, including a definition of CHD and specification of risk factors. The remainder of the chapter will focus on “coronary-prone behavior pattern,” or the Type A behavior pattern, as it relates to the development and maintenance of CHD. As was discussed in Chapter 1, this behavior pattern represents the first well-defined psychological or behavioral risk factor in the history of risk factor research in health and illness. Therefore, the Type A behavior pattern will be emphasized, with a focus on (1) defining the pattern and presenting it in historical perspective, (2) describing the pattern and the methods used to measure and identify it, (3) reviewing the research validating the Type A construct and providing an overview of the psychological aspects of the behavior pattern, and (4) reviewing the psychophysiological
1,289 citations
TL;DR: In documenting the wide distribution and severity of the arterial disease in patients with angina and abnormal electrocardiograms at rest and after exercise the reports parallel earlier views based on comparisons between clinical and morbid findings.
Abstract: CINE coronary arteriography affords a means of correlating clinical manifestations of coronary heart disease with responsible vascular abnormality in the living patient.1 2 3 4 5 Several of the comparative analyses have indicated that obstructing atherosclerosis can be demonstrated in at least 2 major coronary arteries in most patients with angina and abnormal electrocardiograms at rest and after exercise.1 2 3 4 In documenting the wide distribution and severity of the arterial disease in these patients the reports parallel earlier views based on comparisons between clinical and morbid findings.6 Obviously, the correlation does not hold when a significant anomaly of the coronary arteries, aortic regurgitation, aortic stenosis . . .
369 citations
TL;DR: A study of 433 asymptomatic men emphasizes the value of strenuous exercise testing in the early detection of myocardial ischemia and proposes a method of detection and study of potential coronary heart disease and factors influencing its course.
276 citations
Journal Article•
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