Circulation, Vol 57, 64-70, Copyright © 1978 by American Heart Association
JF McNeer, JR Margolis, KL Lee, JA Kisslo, RH Peter, Y Kong, VS Behar, AG Wallace, CB McCants and RA Rosati
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.
ARTICLES
The role of the exercise test in the evaluation of patients for ischemic heart disease
This article has been cited by other articles:
 |
|
 |
|
  X. M. Salvetti, J. A. Oliveira, D. M. Servantes, and A. A. Vincenzo de Paola How much do the benefits cost? Effects of a home-based training programme on cardiovascular fitness, quality of life, programme cost and adherence for patients with coronary disease Clinical Rehabilitation, October 1, 2008; 22(10-11): 987 - 996. [Abstract] [PDF]
|
|
|
|
 |
|
 R. Arena, J. Myers, M. A. Williams, M. Gulati, P. Kligfield, G. J. Balady, E. Collins, and G. Fletcher Assessment of Functional Capacity in Clinical and Research Settings: A Scientific Statement From the American Heart Association Committee on Exercise, Rehabilitation, and Prevention of the Council on Clinical Cardiology and the Council on Cardiovascular Nursing Circulation, July 17, 2007; 116(3): 329 - 343. [Full Text] [PDF]
|
|
|
|
 |
|
 Authors/Task Force Members, K. Fox, M. A. A. Garcia, D. Ardissino, P. Buszman, P. G. Camici, F. Crea, C. Daly, G. De Backer, P. Hjemdahl, et al. Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology Eur. Heart J., June 1, 2006; 27(11): 1341 - 1381. [Full Text] [PDF]
|
|
|
|
 |
|
 P Hjemdahl, S V Eriksson, C Held, L Forslund, P Nasman, and N Rehnqvist Favourable long term prognosis in stable angina pectoris: an extended follow up of the angina prognosis study in Stockholm (APSIS) Heart, February 1, 2006; 92(2): 177 - 182. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Melzer, J. Witte, R. Reibis, H.J. Bondke, W. Combs, K. Stangl, G. Baumann, and H. Theres Predictors of chronotropic incompetence in the pacemaker patient population. Europace, January 1, 2006; 8(1): 70 - 75. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R R T Castro, G Porphirio, S M Serra, and A C L Nobrega Cholinergic stimulation with pyridostigmine protects against exercise induced myocardial ischaemia Heart, October 1, 2004; 90(10): 1119 - 1123. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. J. Gentlesk, T. T. Markwood, and J. E. Atwood Chronotropic Incompetence in a Young Adult: Case Report and Literature Review Chest, January 1, 2004; 125(1): 297 - 301. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. B. Mark and M. S. Lauer Exercise Capacity: The Prognostic Variable That Doesn't Get Enough Respect Circulation, September 30, 2003; 108(13): 1534 - 1536. [Full Text] [PDF]
|
|
|
|
 |
|
 L. Liao and D. B. Mark Clinical prediction models: are we building better mousetraps? J. Am. Coll. Cardiol., September 3, 2003; 42(5): 851 - 853. [Full Text] [PDF]
|
|
|
|
|
|
C Daly, J Norrie, D.L Murdoch, I Ford, H.J Dargie, K Fox, and for the TIBET study group The value of routine non-invasive tests to predict clinical outcome in stable angina Eur. Heart J., March 2, 2003; 24(6): 532 - 540. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. F. Kwok, T. D. Miller, D. O. Hodge, and R. J. Gibbons Prognostic value of the Duke treadmill score in the elderly J. Am. Coll. Cardiol., May 1, 2002; 39(9): 1475 - 1481. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. T. Kuvin, A. R. Patel, K. A. Sliney, N. G. Pandian, W. M. Rand, J. E. Udelson, and R. H. Karas Peripheral vascular endothelial function testing as a noninvasive indicator of coronary artery disease J. Am. Coll. Cardiol., December 1, 2001; 38(7): 1843 - 1849. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. D. Mathes The Preoperative Evaluation of the Patient With Cardiac Risk Factors for Noncardiac Surgery: Which Patients Need Further Cardiac Risk Stratification Tests? Seminars in Cardiothoracic and Vascular Anesthesia, July 1, 2001; 5(2): 154 - 165. [Abstract] [PDF]
|
|
|
|
|
|
M. E. Tavel Stress Testing in Cardiac Evaluation : Current Concepts With Emphasis on the ECG Chest, March 1, 2001; 119(3): 907 - 925. [Full Text] [PDF]
|
|
|
|
|
|
J. L. Fleg, I. L. Pina, G. J. Balady, B. R. Chaitman, B. Fletcher, C. Lavie, M. C. Limacher, R. A. Stein, M. Williams, and T. Bazzarre Assessment of Functional Capacity in Clinical and Research Applications : An Advisory From the Committee on Exercise, Rehabilitation, and Prevention, Council on Clinical Cardiology, American Heart Association Circulation, September 26, 2000; 102(13): 1591 - 1597. [Full Text] [PDF]
|
|
|
|
 |
|
 T. Y. Goraya, S. J. Jacobsen, P. A. Pellikka, T. D. Miller, A. Khan, S. A. Weston, B. J. Gersh, and V. L. Roger Prognostic Value of Treadmill Exercise Testing in Elderly Persons Ann Intern Med, June 6, 2000; 132(11): 862 - 870. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L Forslund, P Hjemdahl, C Held, I Bjorkander, S.V Eriksson, U Brodin, and N Rehnqvist Prognostic implications of results from exercise testing in patients with chronic stable angina pectoris treated with metoprolol or verapamil. A report from The Angina Prognosis Study In Stockholm (APSIS) Eur. Heart J., June 1, 2000; 21(11): 901 - 910. [Abstract] [PDF]
|
|
|
|
 |
|
 J. M. F. Kwok, T. D. Miller, T. F. Christian, D. O. Hodge, and R. J. Gibbons Prognostic Value of a Treadmill Exercise Score in Symptomatic Patients With Nonspecific ST-T Abnormalities on Resting ECG JAMA, September 15, 1999; 282(11): 1047 - 1053. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Ramamurthy, J. E. Kerr, D. Harsha, and M. E. Tavel The Treadmill TestWhere To Stop and What Does It Mean? Chest, April 1, 1999; 115(4): 1166 - 1169. [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]
|
|
|
|
 |
|
 A. P. Michaelides, Z. D. Psomadaki, P. E. Dilaveris, D. J. Richter, G. K. Andrikopoulos, K. D. Aggeli, C. I. Stefanadis, and P. K. Toutouzas Improved Detection of Coronary Artery Disease by Exercise Electrocardiography with the Use of Right Precordial Leads N. Engl. J. Med., February 4, 1999; 340(5): 340 - 345. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. L. Roger, S. J. Jacobsen, P. A. Pellikka, T. D. Miller, K. R. Bailey, and B. J. Gersh Prognostic Value of Treadmill Exercise Testing : A Population-Based Study in Olmsted County, Minnesota Circulation, December 22, 1998; 98(25): 2836 - 2841. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. I. Olmos, H. Dakik, R. Gordon, J. K. Dunn, M. S. Verani, M. A. Quinones, and W. A. Zoghbi Long-Term Prognostic Value of Exercise Echocardiography Compared With Exercise 201Tl, ECG, and Clinical Variables in Patients Evaluated for Coronary Artery Disease Circulation, December 15, 1998; 98(24): 2679 - 2686. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. A. Grady, A. C. Chiu, C. E. Snader, T. H. Marwick, J. D. Thomas, F. J. Pashkow, and M. S. Lauer Prognostic Significance of Exercise-Induced Left Bundle-Branch Block JAMA, January 14, 1998; 279(2): 153 - 156. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. M. Okin, M. S. Lauer, and P. Kligfield Chronotropic Response to Exercise: Improved Performance of ST-Segment Depression Criteria After Adjustment for Heart Rate Reserve Circulation, December 15, 1996; 94(12): 3226 - 3231. [Abstract] [Full Text]
|
|
|
|
|
|
R. F. Wilson Assessing the Severity of Coronary-Artery Stenoses N. Engl. J. Med., June 27, 1996; 334(26): 1735 - 1737. [Full Text]
|
|
|
|
|
|
M. H. Ellestad Chronotropic Incompetence : The Implications of Heart Rate Response to Exercise (Compensatory Parasympathetic Hyperactivity?) Circulation, April 15, 1996; 93(8): 1485 - 1487. [Full Text]
|
|
|
|
|
|
M. S. Lauer, P. M. Okin, M. G. Larson, J. C. Evans, and D. Levy Impaired Heart Rate Response to Graded Exercise : Prognostic Implications of Chronotropic Incompetence in the Framingham Heart Study Circulation, April 15, 1996; 93(8): 1520 - 1526. [Abstract] [Full Text]
|
|
|
|
|
|
E. A. Caracciolo, K. B. Davis, G. Sopko, G. C. Kaiser, S. D. Corley, H. Schaff, H. A. Taylor, and B. R. Chaitman Comparison of Surgical and Medical Group Survival in Patients With Left Main Equivalent Coronary Artery Disease : Long-term CASS Experience Circulation, May 1, 1995; 91(9): 2335 - 2344. [Abstract] [Full Text]
|
|
|
|
|
|
R. E. Patterson, R. L. Eisner, and S. F. Horowitz Comparison of Cost-Effectiveness and Utility of Exercise ECG, Single Photon Emission Computed Tomography, Positron Emission Tomography, and Coronary Angiography for Diagnosis of Coronary Artery Disease Circulation, January 1, 1995; 91(1): 54 - 65. [Abstract] [Full Text]
|
|
|
|
 |
|
 A. Belboul, N. Al-Khaja, A. El-Gatit, Bo Liu, D. Roberts, and G. William-Olsson Late Improvement in Blood Cell Filterability and Cardiac Function Following Open Heart Surgery Vascular and Endovascular Surgery, September 1, 1992; 26(7): 543 - 551. [Abstract] [PDF]
|
|
|
|
|
|
M. M. Bodenheimer Risk Stratification in Coronary Disease: A Contrary Viewpoint Ann Intern Med, June 1, 1992; 116(11): 927 - 936. [Abstract] [PDF]
|
|
|
|
 |
|
 B. L. Hubbard, R. J. Gibbons, A. C. Lapeyre III, A. R. Zinsmeister, and I. P. Clements Identification of Severe Coronary Artery Disease Using Simple Clinical Parameters Arch Intern Med, February 1, 1992; 152(2): 309 - 312. [Abstract] [PDF]
|
|
|
|
|
|
J. B. Wong, F. A. Sonnenberg, D. N. Salem, and S. G. Pauker Myocardial Revascularization for Chronic Stable Angina: Analysis of the Role of Percutaneous Transluminal Coronary Angioplasty Based on Data Available in 1989 Ann Intern Med, December 1, 1990; 113(11): 852 - 871. [Abstract] [PDF]
|
|
|
|
|
|
T. S. Kotler and G. A. Diamond Exercise Thallium-201 Scintigraphy in the Diagnosis and Prognosis of Coronary Artery Disease Ann Intern Med, November 1, 1990; 113(9): 684 - 702. [Abstract] [PDF]
|
|
|
|
|
|
R. J. Gibbons, A. R. Zinsmeister, T. D. Miller, and I. P. Clements Supine Exercise Electrocardiography Compared with Exercise Radionuclide Angiography in Noninvasive Identification of Severe Coronary Artery Disease Ann Intern Med, May 15, 1990; 112(10): 743 - 749. [Abstract] [PDF]
|
|
|
|
|
|
H. C. Sox Jr., B. Littenberg, and A. M. Garber The Role of Exercise Testing in Screening for Coronary Artery Disease Ann Intern Med, March 15, 1989; 110(6): 456 - 469. [Abstract] [PDF]
|
|
|
|
 |
|
 T. H. Lee, T. Fukui, M. C. Weinstein, A. N.A. Tosteson, and L. Goldman Cost-Effectiveness of Screening Strategies for Left Main Coronary Artery Disease in Patients with Stable Angina Med Decis Making, December 1, 1988; 8(4): 268 - 278. [Abstract] [PDF]
|
|
|
|
|
|
D. B. MARK, M. A. HLATKY, F. E. HARRELL Jr., K. L. LEE, R. M. CALIFF, and D. B. PRYOR Exercise Treadmill Score for Predicting Prognosis in Coronary Artery Disease Ann Intern Med, June 1, 1987; 106(6): 793 - 800. [Abstract] [PDF]
|
|
|
|
 |
|
 D. V. Cokkinos, A. Papantonakos, C. Perrakis, S. Argyrakis, G. Kouvaras, A. Tzonou, and K. Patsouros The Influence of R-Wave Amplitude on the Degree of ST-Segment Depression in Exercise Electrocardiography in the Individual Patient Angiology, January 1, 1987; 38(1): 22 - 27. [Abstract] [PDF]
|
|
|
|
|
|
D. B. MARK, M. A. HLATKY, K. L. LEE, F. E. HARRELL Jr., R. M. CALIFF, and D. B. PRYOR Localizing Coronary Artery Obstructions with the Exercise Treadmill Test Ann Intern Med, January 1, 1987; 106(1): 53 - 55. [Abstract] [PDF]
|
|
|
|
|
|
W. F. ARMSTRONG, J. O'DONNELL, J. C. DILLON, P. L. McHENRY, S. N. MORRIS, and H. FEIGENBAUM Complementary Value of Two-Dimensional Exercise Echocardiography to Routine Treadmill Exercise Testing Ann Intern Med, December 1, 1986; 105(6): 829 - 835. [Abstract] [PDF]
|
|
|
|
|
|
S. P. Van Camp and R. A. Peterson Cardiovascular Complications of Outpatient Cardiac Rehabilitation Programs JAMA, September 5, 1986; 256(9): 1160 - 1163. [Abstract] [PDF]
|
|
|
|
|
|
T. H. Lee, E. F. Cook, and L. Goldman Prospective Evaluation of a Clinical and Exercise-test Model for the Prediction of left Main Coronary Artery Disease Med Decis Making, August 1, 1986; 6(3): 136 - 144. [Abstract] [PDF]
|
|
|
|
|
|
R. F. LEIGHTON and T. D. FRAKER JR. Silent Myocardial Ischemia: Concern Is Justified for the Patient with Known Coronary Artery Disease Ann Intern Med, April 1, 1984; 100(4): 599 - 601. [Abstract] [PDF]
|
|
|
|
|
|
F. E. Harrell Jr, R. M. Califf, D. B. Pryor, K. L. Lee, and R. A. Rosati Evaluating the Yield of Medical Tests JAMA, May 14, 1982; 247(18): 2543 - 2546. [Abstract] [PDF]
|
|
|
|
|
|
N. Belie and J. M. Gardin ECG Manifestations of Myocardial Ischemia Arch Intern Med, September 1, 1980; 140(9): 1162 - 1165. [Abstract] [PDF]
|
|
|
|
|
|
M. B. Bodenheimer, V. S. Banka, C. M. Fooshee, and R. H. Helfant Extent and Severity of Coronary Heart Disease: Determinations by Thallous Chloride Tl 201 Myocardial Perfusion Scanning and Comparison With Stress Electrocardiography Arch Intern Med, June 1, 1979; 139(6): 630 - 634. [Abstract] [PDF]
|
|