Froelicher V F
Annu Rev Med. 1977;28:1-12. doi: 10.1146/annurev.me.28.020177.000245.
In summary, near-maximal or maximal exercise testing has a sensitivity of approximately 60% and a specificity of approximately 90% for coronary atherosclerotic heart disease. When screening asympatomatic men with exercise testing, an abnormal response identifies a group of men at very high risk for coronary artery disease. However, the predictive value limitations are obvious and the false-positive problem must be realized. At present, there is no second line of noninvasive studies that can separate an exercise-test false positive from a true positive with certainty. Risk-factor consideration may help separate them; The sensitivity limitations of exercise testing must be especially considered when evaluating people at high risk for CAD. An abnormal test response does not absolutely predict the presence of CAD and a normal response does not rule out its possibility. In appropriate instances where coronary angiography can be performed at minimal risk and when it is justified for reasons of public safety or individual well-being, this procedure can give a reasonably definitive answer. Creation of iatrogenic "cardiac cripples" can be the most common complication of screening tests and should be avoided. Therefore, good clinical judgment needs to be used in conjunction with any screening test.
总之，对于冠状动脉粥样硬化性心脏病，接近最大或最大运动试验的敏感性约为60%，特异性约为90%。当对无症状男性进行运动试验筛查时，异常反应可识别出一组患冠状动脉疾病风险极高的男性。然而，预测价值的局限性很明显，必须认识到假阳性问题。目前，尚无二线无创研究能够确切区分运动试验的假阳性和真阳性。考虑危险因素可能有助于区分两者；在评估冠心病高危人群时，必须特别考虑运动试验的敏感性局限性。异常的试验反应并不能绝对预测冠心病的存在，而正常反应也不能排除其可能性。在可以以最小风险进行冠状动脉造影且出于公共安全或个人健康原因合理的适当情况下，该检查可给出相当明确的答案。医源性“心脏残废”可能是筛查试验最常见的并发症，应予以避免。因此，任何筛查试验都需要结合良好的临床判断。
