Present status of exercise testing in the evaluation of coronary artery disease.

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  • Present Status of Exercise Testing in t

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The present status of exercise testing in coronary artery disease (CAD) was discussed in respect to test protocols, ECG criteria and lead systems, and hemodynamic responses. Advantages of modern multistage protocols over single-stage ones such as Master two-step tests are obvious in diagnostic accuracy and patient's safety. Clinical significance of horizontal and downsloping ST depression has already been established. Diagnostic significance of other exercise-induced ECG alterations such as slow upsloping ST depression, ST elevation, U-wave inversion, and R-wave amplitude changes was discussed. The latter parameter is still controversial as to its clinical significance. Use of an inadequate ECG lead system is one of major causes of false negative tests. Necessity of multiple lead systems was emphasized for higher diagnostic accuracy. From the view point of cost-efficacy relation, we will recommend simultaneous recording of CC5 or CM5, V3 and CL or III in routine exercise testing for screening of CAD. Test results such as exercise time, and heart rate and systolic blood pressure responses are also useful parameters for the evaluation of the severity and prognosis of CAD. It was emphasized that inexercise monitoring of ECG and blood pressure is indispensible in multistage exercise testing for improvement of diagnostic accuracy as well as patient's safety.

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