The changing role of the exercise electrocardiogram as a diagnostic and prognostic test for chronic ischemic heart disease
BR Chaitman
The exercise electrocardiogram has been the subject of intense research over the last 50 years, as both a diagnostic and prognostic method to assess patients with chronic ischemic heart disease. In 1986, the strengths and limitations of the technique to predict coronary and multivessel disease in clinical patient subsets are understood. The diagnostic accuracy of the test is improved by consideration of Bayesian theory, multivariate models and new non-ST segment criteria. Post-test coronary disease risk estimates are best reported in terms of a conditional probability, rather than statements of "positive" or "negative." The value of exercise testing in prognostic risk stratification is considerably enhanced by recent reports of long-term follow-up data in asymptomatic and symptomatic patients. Powerful prognostic information can be obtained when the clinical, electrocardiographic and physiologic data from the exercise test are used to formulate the post-test risk of a cardiac event, even in patients whose coronary anatomy is known. The changing role of the exercise electrocardiogram as a diagnostic and prognostic test is reviewed, with emphasis on the strengths and limitations of the procedure.
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November 24, 2009;
54(22):
e13 - e118.
[Full Text]
[PDF]
|
|
|
|
|
|
|
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November 24, 2009;
120(21):
e169 - e276.
[Full Text]
[PDF]
|
|
|
|
|
|
|
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J. Am. Coll. Cardiol.,
October 23, 2007;
50(17):
e159 - e242.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, et al.
ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery)
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October 23, 2007;
116(17):
e418 - e500.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Kligfield and M. S. Lauer
Exercise Electrocardiogram Testing: Beyond the ST Segment
Circulation,
November 7, 2006;
114(19):
2070 - 2082.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S K S Lairikyengbam and A G Davies
Interpreting exercise treadmill tests needs scoring system
BMJ,
August 24, 2002;
325(7361):
443 - 443.
[Full Text]
|
|
|
|
|
|
|
M. L. Geleijnse, A. Elhendy, P. M. Fioretti, and J. R. T. C. Roelandt
Dobutamine stress myocardial perfusion imaging
J. Am. Coll. Cardiol.,
December 1, 2000;
36(7):
2017 - 2027.
[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]
|
|
|
|
|
|
|
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]
|
|
|
|
|
|
|
L. J. Shaw, E. D. Peterson, L. K. Shaw, K. L. Kesler, E. R. DeLong, F. E. Harrell Jr, L. H. Muhlbaier, and D. B. Mark
Use of a Prognostic Treadmill Score in Identifying Diagnostic Coronary Disease Subgroups
Circulation,
October 20, 1998;
98(16):
1622 - 1630.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. L. Geleijnse, A. Elhendy, R. T. van Domburg, J. H. Cornel, R. Rambaldi, A. Salustri, A. E. M. Reijs, J. R. T. C. Roelandt, and P. M. Fioretti
Cardiac Imaging for Risk Stratification With Dobutamine-Atropine Stress Testing in Patients With Chest Pain : Echocardiography, Perfusion Scintigraphy, or Both?
Circulation,
July 1, 1997;
96(1):
137 - 147.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
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]
|
|
|
|
|
|
|
M. M. Bodenheimer
Risk Stratification in Coronary Disease: A Contrary Viewpoint
Ann Intern Med,
June 1, 1992;
116(11):
927 - 936.
[Abstract]
[PDF]
|
|
|
|
|
|
|
A. Hamsten
Myocardial infarction at a young age: mechanisms and management
Vascular Medicine,
March 1, 1991;
2(1):
45 - 60.
[PDF]
|
|
|
|
|
|
|
M. D. Cheitlin
Finding the High-Risk Patient With Coronary Artery Disease
JAMA,
April 15, 1988;
259(15):
2271 - 2277.
[Abstract]
[PDF]
|
|
|
|
