[The sensitivity and specificity of the ergometric test for the diagnosis of coronary disease].

According to the principles of probabilistic analysis, sensitivity and specificity of a diagnostic test are fixed values. Nevertheless, most authors consider them to be inconstant values, specially when applied to the diagnosis of coronary heart disease by exercise stress test. In this paper, we review the basic concepts on sensitivity and specificity of diagnostic tests and try to explain their supposed variability, when related to exercise test, as a function of undue comparison between ST-segment response and the findings of cinecoronariography. Based on the essential difference between coronary heart disease and ischemic heart disease, we demonstrate why such an equivocal comparison can lead to false results of sensitivity and specificity of exercise tests relative to coronary heart disease. As a result, their alleged variability depends most on the prevalence of ischemia throughout the spectrum of coronary heart disease in the studied population. As a matter of fact, unless one can rely on a method as a gold standard for the diagnosis of ischemic heart disease, the real sensitivity and specificity of exercise stress test should be considered as unknown values.