Diagnostic and prognostic value of exercise electrocardiography for coronary artery disease.

A positive exercise ECG with greater than or equal to 1.0 mm ischemic ST-segment depression, limited exercise duration, persistence of ischemic ST-segment depression past 8 minutes in the recovery period, and exertional hypotension is associated with increasing severity and extent of CAD. The sensitivity and specificity of the exercise ECG are not dependent on the prevalence of CAD in the population tested. The positive and negative predictive values of the exercise ECG are both dependent on the prevalence of CAD in the population tested. Exercise-induced ST-segment elevation greater than or equal to 1.0 mm is associated with severe myocardial ischemia, left ventricular aneurysm, left ventricular wall motion abnormalities, and coronary artery spasm in patients with variant angina. Ischemic ST-segment depression greater than or equal to 1.0 mm, exercise duration, maximal exercise heart rate, and blood pressure response to exercise are correlated with new coronary events in patients with documented CAD. Low-level exercise tests within 3 weeks of uncomplicated MI can identify patients at high risk for new cardiac events. Early post-MI patients with exercise-induced ischemic ST-segment depression greater than or equal to 1.0 mm, exercise-induced angina, an inadequate blood pressure response to exercise, or limited exercise duration during a low-level exercise test should undergo coronary angiography and be considered for possible coronary artery surgery or angioplasty. Exercise testing will also help in the medical treatment of patients with exercise-induced angina or malignant ventricular arrhythmias. An exercise test performed 6 months after MI also provides prognostic information not available from clinical evaluation.(ABSTRACT TRUNCATED AT 250 WORDS)