Document Detail

The diagnostic and prognostic value of exercise electrocardiography in asymptomatic subjects and stable symptomatic patients.
MedLine Citation:
PMID:  10149589     Owner:  NLM     Status:  MEDLINE    
In asymptomatic patients, the use of exercise ECG testing for the detection of subclinical coronary artery disease has considerable theoretical appeal, but its practical application is severely hampered by the constraints of Bayes' theorem. Serial exercise ECGs do not appear to offer significant improvement in this regard. Thallium-201 perfusion scintigraphy performed in conjunction with an exercise ECG can greatly improve the predictive value of such testing, although at considerable cost. Screening strategies with promise are those that reserve exercise testing for individuals at greater-than-average risk for subclinical coronary artery disease (eg, patients with multiple coronary risk factors) or that prescribe sequential testing, where only those with an abnormal exercise ECG are subjected to thallium-201 scintigraphy. At present, the optimal method of identifying asymptomatic individuals at high risk of a major cardiac event remains undefined. The use of maximal-effort stress testing has stood the test of time in the evaluation of patients with stable symptoms suggestive of coronary artery disease. This is particularly true when variables other than the ECG response to exercise are considered. The independent contribution of exercise angina remains controversial; however, recent studies indicate that it correlates with a more severe symptom pattern and more extensive coronary artery disease. Prognostic stratification in these studies was improved by considering both subjective and objective manifestations of ischemia. Although exercise ECG testing has been shown to have important prognostic value after acute myocardial infarction, exercise thallium-201 scintigraphy offers several potential advantages for asymptomatic post-myocardial infarction patients, several of which this paper reviews. The more optimal prognostic efficiency of thallium-201 scintigraphy is due in part to the fact that the error rate in falsely classifying patients at low risk is substantially smaller with scintigraphy than with stress electrocardiography. Because of this, there appears to be adequate rationale for recommending exercise perfusion imaging, rather than exercise ECG testing alone, as the preferred method for evaluating mortality and morbidity risks after acute myocardial infarction.
R S Gibson
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Current opinion in cardiology     Volume:  6     ISSN:  0268-4705     ISO Abbreviation:  Curr. Opin. Cardiol.     Publication Date:  1991 Aug 
Date Detail:
Created Date:  1992-08-27     Completed Date:  1992-08-27     Revised Date:  2006-05-04    
Medline Journal Info:
Nlm Unique ID:  8608087     Medline TA:  Curr Opin Cardiol     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  536-46     Citation Subset:  T    
University of Virginia, Charlottesville.
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MeSH Terms
Coronary Disease / diagnosis*,  physiopathology,  radionuclide imaging
Electrocardiography / methods*
Exercise Test*
Predictive Value of Tests
Thallium Radioisotopes / diagnostic use
Reg. No./Substance:
0/Thallium Radioisotopes

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