Fowler-Brown Angela, Pignone Michael, Pletcher Mark, Tice Jeffrey A, Sutton Sonya F, Lohr Kathleen N
Division of General Internal Medicine, University of North Carolina at Chapel Hill and Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC 27599-7110, USA.
Ann Intern Med. 2004 Apr 6;140(7):W9-24. doi: 10.7326/0003-4819-140-7-200404060-w1.
Coronary heart disease is the leading cause of morbidity and mortality in the United States. Exercise tolerance testing has been proposed as a means of better identifying asymptomatic patients at high risk for coronary heart disease events.
To review the evidence on the use of exercise tolerance testing to screen adults with no history of cardiovascular disease for coronary heart disease.
The MEDLINE database from 1966 through February 2003, hand-searching of bibliographies, and expert input.
Eligible studies evaluated the benefits or harms of exercise tolerance testing when added to traditional risk assessment for adults with no known history of cardiovascular events.
One reviewer extracted information from eligible articles into evidence tables, and another reviewer checked the tables. Disagreements were resolved by consensus.
No study has directly examined the effect of screening asymptomatic patients with exercise tolerance testing on coronary heart disease outcomes or risk-reducing behaviors or therapies. Multiple cohort studies demonstrate that screening exercise tolerance testing identifies a small proportion of asymptomatic persons (up to 2.7% of those screened) with severe coronary artery obstruction who may benefit from revascularization. Several large prospective cohort studies, conducted principally in middle-aged men, suggest that exercise tolerance testing can provide independent prognostic information about the risk for future coronary heart disease events (relative risk with abnormal exercise tolerance testing, 2.0 to 5.0). However, when the risk for coronary heart disease events is low, most positive findings will be false and may result in unnecessary further testing or worry. The risk level at which the benefits of additional prognostic information outweigh the harms of false-positive results is unclear and requires further study.
Although screening exercise tolerance testing detects severe coronary artery obstruction in a small proportion of persons screened and can provide independent prognostic information about the risk for coronary heart disease events, the effect of this information on clinical management and disease outcomes in asymptomatic patients is unclear.
冠心病是美国发病和死亡的主要原因。运动耐量测试已被提议作为一种更好地识别冠心病事件高危无症状患者的方法。
回顾关于使用运动耐量测试对无心血管疾病史的成年人进行冠心病筛查的证据。
1966年至2003年2月的MEDLINE数据库、文献目录手工检索以及专家意见。
符合条件的研究评估了在对无已知心血管事件史的成年人进行传统风险评估时增加运动耐量测试的益处或危害。
一名审阅者从符合条件的文章中提取信息并填入证据表，另一名审阅者检查表格。分歧通过协商解决。
没有研究直接考察对无症状患者进行运动耐量测试筛查对冠心病结局或降低风险行为及治疗的影响。多项队列研究表明，筛查性运动耐量测试可识别一小部分（筛查人群中高达2.7%）有严重冠状动脉阻塞的无症状者，他们可能从血运重建中获益。几项主要在中年男性中进行的大型前瞻性队列研究表明，运动耐量测试可为未来冠心病事件风险提供独立的预后信息（运动耐量测试异常时的相对风险为2.0至5.0）。然而，当冠心病事件风险较低时，大多数阳性结果将是假阳性，可能导致不必要的进一步检查或担忧。额外预后信息的益处超过假阳性结果危害的风险水平尚不清楚，需要进一步研究。
尽管筛查性运动耐量测试能在一小部分筛查者中检测到严重冠状动脉阻塞，并可为冠心病事件风险提供独立的预后信息，但该信息对无症状患者临床管理和疾病结局的影响尚不清楚。
