Today, I review, link to, and excerpt from Value of Exercise Stress Electrocardiography for Risk Stratification in Patients With Suspected or Known Coronary Artery Disease in the Era of Advanced Imaging Technologies. [PubMed Abstract] [Full-Text HTML] [Full-Text PDF]. JACC Cardiovasc Imaging. 2015 Nov;8(11):1309-21. doi: 10.1016/j.jcmg.2015.09.006.
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Abstract
Exercise stress electrocardiography (ExECG) is underutilized as the initial test modality in patients with interpretable electrocardiograms who are able to exercise. Although stress myocardial imaging techniques provide valuable diagnostic and prognostic information, variables derived from ExECG can yield substantial data for risk stratification, either supplementary to imaging variables or without concurrent imaging. In addition to exercise-induced ischemic ST-segment depression, such markers as ST-segment elevation in lead aVR, abnormal heart rate recovery post-exercise, failure to achieve target heart rate, and poor exercise capacity improve risk stratification of ExECG. For example, patients achieving ≥10 metabolic equivalents on ExECG have a very low prevalence of inducible ischemia and an excellent prognosis. In contrast, cardiac imaging techniques add diagnostic and prognostic value in higher-risk populations (e.g., poor functional capacity, diabetes, or chronic kidney disease). Optimal test selection for symptomatic patients with suspected coronary artery disease requires a patient-centered approach factoring in the risk/benefit ratio and cost-effectiveness.
Keywords: exercise stress electrocardiography; myocardial ischemia; risk stratification.
Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
