This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by SHEFFIELD, L. T. Articles by REEVES, T. J. Search for Related Content PubMed PubMed Citation Articles by SHEFFIELD, L. T. Articles by REEVES, T. J. Pubmed/NCBI databases Medline Plus Health Information Angina

(Circulation. 1965;32:622.)
© 1965 American Heart Association, Inc.

---

Exercise Graded by Heart Rate in Electrocardiographic Testing for Angina Pectoris

L. T. SHEFFIELD M.D.¹; JOHN H. HOLT M.D.¹; T. JOSEPH REEVES M.D.¹

¹ From the Department of Medicine, Medical College of Alabama, and the Medical Service, Veterans Administration Hospital, University of Alabama Medical Center, Birmingham, Alabama.

Standardization of an exercise electrocardiographic test for myocardial ischemia is desirable. Standardization of exercise should be based upon a standardized challenge to the coronary circulation, not upon a standardized challenge to the skeletal muscles, for the stresses upon the heart are not identical.

With the use of heart rate during exercise as an index of cardiac stress, the levels of exercise prescribed on the basis of age, sex, and weight in standard "two-step" test tables produce widely varying levels of cardiac stress-sometimes too low to induce significant ST-segment depression in patients with angina pectoris and, occasionally, much greater than necessary to produce such diagnostic electrocardiographic changes.

The graded exercise test, using 85 per cent of the maximal age-predicted heart rate that may be induced by exercise, produces a closer approximation of a standardized cardiac stress, regardless of age, sex, or body build. Its use with angina pectoris patients and normal subjects results in increased sensitivity (fewer false negatives) and increased specificity (fewer false positives).

Use of the graded exercise test as described is considered not to increase the hazard of testing, and perhaps even to decrease it.

This article has been cited by other articles:

				Y K Wong, S Dawkins, R Grimes, F Smith, K D Dawkins, and I A Simpson Improving the positive predictive value of exercise testing in women Heart, December 1, 2003; 89(12): 1416 - 1421. [Abstract] [Full Text] [PDF]

				S. N. Chatziioannou, W. H. Moore, P. V. Ford, R. E. Fisher, V.-V. Lee, C. Alfaro-Franco, and R. D. Dhekne Prognostic Value of Myocardial Perfusion Imaging in Patients With High Exercise Tolerance Circulation, February 23, 1999; 99(7): 867 - 872. [Abstract] [Full Text] [PDF]

				M. Sekiya, M. Suzuki, Y. Fujiwara, T. Sumimoto, M. Hamada, and K. Hiwada Hemodynamic Characteristics of Patients with Coronary Artery Disease Presenting False-Negative Exercise Stress Test Angiology, June 1, 1992; 43(6): 506 - 511. [Abstract] [PDF]

				H. Ikram, W.C. Chan, P.J. Bones, and E. Sherry Factors Influencing the Diagnostic Sensitivity of the Exercise Test in Coronary Artery Disease Angiology, April 1, 1980; 31(4): 246 - 253. [PDF]

				Y. Eshchar, J.H. Yahini, P. Atlas, Y. Kishon, V. Deutsch, and H.N. Neufeld Exercise Tests in Patients With Severe Angina Pectoris: An Angiographic Correlation Angiology, January 1, 1980; 31(1): 32 - 38. [Abstract] [PDF]

				S. Rubler and S. B. Arvan Exercise Testing in Young Asymptomatic Diabetic Patients Angiology, September 1, 1976; 27(9): 539 - 548. [Abstract] [PDF]